Bird flu's unprecedented spread among livestock and other mammals in the U.S. has raised fears that another pandemic could be in store.

The incoming Trump administration will have to prepare for this risk. As H5N1 spills into more people and animals, scientists warn it could evolve to better infect humans and become more dangerous.

Trump and his picks to helm federal health agencies have largely been silent on bird flu. The messaging so far — and the track record of those Trump has chosen to oversee a potential bird flu crisis — is "worrisome," says Dr. Andrew Pavia, professor of medicine at the University of Utah who's worked on influenza pandemic preparedness for more than two decades.

The transition team did not respond to NPR's request for comment on its plans.

Trump's choice to lead the Department of Health and Human Services, Robert F Kennedy Jr., has an extensive history of making inaccurate and misleading statements on vaccines and infectious diseases. He's a lawyer who for years led an advocacy group that is a major player in the anti-vaccine movement, promoting the long-debunked idea that vaccines lead to autism, among other false claims.

Kennedy denies spreading misinformation, though his criticism of vaccines is well known.

He's also made specific comments undermining trust in the bird flu vaccines. In an online post last summer, he claimed there's "no evidence" the licensed shots for the national stockpile will work and that they "appear dangerous."

And he suggested in another post that "someone" might bioengineer a dangerous form of the virus to profit off the vaccine.

Scientists who study the vaccines are deeply troubled by these statements.

"They are false, baseless and inaccurate," says Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia.

Kennedy has also discussed having the National Institutes of Health take a break from infectious disease research for eight years, and replacing hundreds of employees there.

Trump himself suggested last spring that he'd like to disband an office in the executive branch that handles pandemics.

If confirmed as health secretary, Kennedy would have broad powers. He could declare a public health emergency, control and direct funding, and influence key decisions at the Centers for Disease Control and Prevention, the Food and Drug Administration, and NIH, all of which are overseen by HHS.

"At every step, he can certainly play a role in hampering or being a barrier," says Syra Madad, director of the special pathogens program at NYC Health + Hospitals.

This could be of huge consequence for how prepared the country is to face an escalating crisis. Still, some scientists point to the first Trump administration's speedy work on a COVID-19 vaccine with Operation Warp Speed, and say they think that ultimately Kennedy would need to listen to Trump if he called for a similar effort.

"If the president tells him to do something, I would hope that would be the case," says Dr. Carlos del Rio, a professor of medicine at Emory University. "And let's be honest, there has been a lot of failure in the current response."

An urgent need to prepare
Bird flu currently doesn't pose an imminent threat to the American public — most of the 67 human cases since last April have only led to mild illness and were caused by direct exposure to infected animals.

But, scientists caution, things could change quickly.

"This is like some brush burning around your house," says Dr. Jesse Goodman, an infectious disease physician at Georgetown University and a former FDA official.

"You better pay attention because it could turn into something else."

To prepare for this threat, the U.S. must strengthen the pipeline of vaccines and treatments for bird flu, says Pavia. The Trump administration will need to help bolster supplies of the existing shots and support development of new ones.

"We are fooling ourselves that we have enough vaccine capacity and the ability to respond quickly," he warns.

Already under the Biden administration, scientists have criticized the federal government for the slow pace of its response.

"There's a lot of work that still needs to be done," says Jennifer Nuzzo, who directs the Pandemic Center at Brown University School of Public Health, adding that it's not like "handing over the keys to the car with the engine running."

Two weeks ago — more than nine months after the outbreak was first detected in cattle — health officials announced an investment of more than $300 million into pandemic readiness for bird flu. It wasn't until December that the federal government took key steps to track the spread in dairy cattle.

"We're flying blind just like we did during COVID-19," says Madad.

Alongside vaccines, public health experts have outlined a list of urgent tasks to battle bird flu, including: working with the industry to improve biosecurity measures and testing on farms; coordinating with state and local authorities on the ground; and planning for contingencies.

There are gaps in disease surveillance efforts on farms. And ultimately public health agencies have limited authority in this area, says Dr. Luciana Borio who served as the FDA's chief acting scientist from 2015 to 2017 and is now a fellow at the Council on Foreign Relations.

"That means we have to put even more effort into developing new vaccines and therapeutics more quickly," she says. "We can't just hope that this is going to go away."

Casting doubt on vaccines
Kennedy has grabbed headlines for promoting raw milk despite the public health warnings that it can harbor the bird flu virus. His views on vaccines could be even more consequential.

The Health Secretary could influence the rollout of a vaccine campaign and communication with the public. While it's rare to do so, he could even override FDA decisions on vaccine approvals and authorizations, and how the CDC comes up with recommendations, notes James Hodge, a law professor at Arizona State University.

"There's much he could do to disrupt vaccine programs in this country," says Offit. "I have little doubt that were he to pass his confirmation hearing, that's exactly what he'll do."

Last year, Kennedy took direct aim at bird flu vaccines in several posts on X.

He cited the pharmaceutical industry's financial interest in developing bird flu vaccines and he raised a conspiracy theory, suggesting that the government's work on bird flu vaccines may be in anticipation of a "lab-derived pandemic."

In June, he wrote: "With so much money on the table, is it conceivable that someone might deliberately release a bioengineered bird flu?"

Dr. Andrew Pekosz calls the idea "preposterous," and points out that developing vaccines ahead of time is exactly what needs to be done, in case a crisis emerges in the future.

"This is the planning and preparedness that public health officials and scientists do to be ready to respond," says Pekosz, a professor of microbiology at Johns Hopkins Bloomberg School of Public Health. "Those vaccines could be the primary way we protect our population from a potential H5N1 pandemic."

And contrary to Kennedy's statement raising a safety concern, the existing bird flu vaccines, as with the seasonal influenza shots, "have shown a safety record," he says. "They're not dangerous."

Those vaccines were developed to target older strains of bird flu and approved based on clinical data that looked at their safety and the immune response the vaccines elicited in participants.

The federal government is now having manufacturers update these shots to more closely target the strain of bird flu in circulation — similar to what's done with seasonal influenza every year — and is gathering more data based on new studies, which aren't yet published.

It's expected there will be about 10 million doses stockpiled by the spring.

Kennedy's claim there's "no evidence" the vaccines will work is misleading because their effectiveness can only be determined in human trials once a bird flu virus is actually spreading between people, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy.

"There's no way we could know because we don't have the virus that's going to cause the next pandemic yet," he says.

However, health officials have noted that the newer vaccines, ordered by the federal government for the national stockpile, appear well-matched against the virus circulating in animals, according to lab research on the immune response they generate.


There is also separate data published last July showing the originally licensed vaccines induce antibodies "that likely would be protective" against the current strain, says Offit, though you can't know for sure without vaccine effectiveness studies.

If the virus changes significantly and begins spreading among people, it's entirely possible the vaccine will need to be updated further. That's why the federal government is not preemptively manufacturing hundreds of millions of doses right now, according to David Boucher, a senior official with the Administration for Strategic Preparedness and Response.

'A swift response'
In the event of a bird flu pandemic, Nuzzo says she expects Americans will "demand" vaccines, given just how deadly this virus might be.

"What I am worried about is whether any ideological opposition, or perhaps lack of understanding of science, gets in the way of a swift response," she says.

If the virus started spreading among humans, the country would not be able to manufacture all the needed shots in a rapid timeframe.

It would take about six months to churn out 150 million doses, and even longer if the virus had changed enough to warrant another update, says Boucher. And that's still not nearly enough to protect the entire U.S. population of more than 330 million people.

These concerns have prompted the federal government to invest in mRNA vaccine technology for bird flu as was done for COVID-19. These shots could be manufactured in a much faster timeframe.

Borio believes the government's work to accelerate development on new bird flu vaccines will continue under Trump, based on her experience working under the first Trump administration.

"No president or Congress wants to see people dying needlessly of an influenza pandemic," she says.

For his part, Trump's pick to lead the FDA, Dr. Marty Makary, has pushed back on concerns that Kennedy's stance on vaccines should disqualify him from being secretary.

But this transition period is a delicate moment, when the country could be caught off guard if the situation suddenly changes, says Goodman, who recommends the Biden administration share its pandemic playbook so incoming officials can game out different pandemic scenarios and assess readiness. He also cautions that Trump's team needs to preserve the federal workforce, including the career scientists, who have the knowledge on bird flu and pandemics.

"You want to keep the best people, not scare them away," with "extreme rhetoric," he says.

As Trump brings in new people, Pavia hopes he taps those with bird flu expertise, saying there are plenty of "conservative choices," with backgrounds in biodefense and the military. After all, it was President George W. Bush who emphasized the threat of bird flu 20 years ago.

"What you can't do is bring in novices. You can't bring in people who don't have any experience with the diseases or with the complexities of a response," he says. "Mother Nature doesn't care what your politics or your policies are."

NEW YORK (AP) — The Biden administration on Tuesday released a “roadmap” for maintaining government defenses against infectious diseases, just as President-elect Donald Trump pledges to dismantle some of them.

The 16-page report recaps steps taken in the last four years against COVID-19, mpox and other diseases, including vaccination efforts and the use of wastewater and other measures to spot signs of erupting disease outbreaks. It’s a public version of a roughly 300-page pandemic-prevention playbook that Biden officials say they are providing to the incoming administration.

Biden officials touted the steps they took to halt or prevent disease threats, but some public heath researchers offer a more mixed assessment of the administration’s efforts. Several experts, for example, said not nearly enough has been done to make sure an expanding bird flu pandemic in animals doesn’t turn into a global health catastrophe for people.

“Overwhelmingly you’ve heard a lot of frustration by outside experts that we’ve been under-reacting to what we see as really serious threat,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health.

Public health experts worry the next administration could do less
Trump and his team plan to slash government spending, and Trump has endorsed prominent vaccine detractors for top government health posts. During the campaign last year, Trump told Time magazine that he would disband the White House office focused on pandemic preparedness, calling it “a very expensive solution to something that won’t work.”

Public health researchers also point to Trump’s first administration, when the White House in 2018 dismantled a National Security Council pandemic unit. When COVID-19 hit two years later, the government’s disjointed response prompted some experts to argue that the unit could have helped a faster and more uniform response.

In 2020, during the pandemic, Trump officials moved to pull the U.S. out of the World Health Organization. President Joe Biden reversed the decision, but Trump’s team is expected to do it again. Experts say such a move would, among other things, hurt the ability to gain information about emerging new outbreaks before they comes to U.S. shores.

Officials with the Trump transition team did not respond to emails requesting information about its pandemic planning.

Many public health experts praise Trump for “ Operation Warp Speed, ” which helped spur the rapid development of COVID-19 vaccines. But several also noted that decades of planning and research under previous administrations laid the groundwork for it.

What do Biden officials say they accomplished?
COVID-19 vaccines did not start to trickle out to the public until after Biden defeated Trump in the 2020 election, and it was the Biden administration that stood up what it describes as the largest free vaccination program in U.S. history.

“President Biden came to office amidst the worst public health crisis in more than a century,” said Dr. Paul Friedrichs, director of the White House Office of Pandemic Preparedness and Response Policy, in a statement. “He partnered with stakeholders across the nation and turned it around, ending the pandemic and saving countless lives.”

Friedrichs’s office was established by Congress in 2022. He said the administration has “laid the foundation for faster and more effective responses to save lives now and in the future.”

What has been done to prepare for bird flu and other threats?
The pandemic office, which released the report Tuesday, said it has taken steps to fight bird flu, which has been spreading among animal species in scores of countries in the last few years.

The virus was detected in U.S. dairy herds in March. At least 66 people in the U.S. have been diagnosed with infections, the vast majority of them dairy or poultry workers who had mild infections. But that count includes an elderly Louisiana man who died.

Among other steps, the administration is stockpiling 10 million doses of vaccine that is considered effective against the strain that’s been circulating in U.S. cattle, and spent $176 million to develop mRNA vaccines that could quickly be adapted to mutations in the virus, with late stage trials “beginning shortly,” the document says.

READ MORE: Louisiana patient is the first to die of bird flu in the U.S., health officials say

Having measures in place to quickly develop and mass produce new vaccines is crucial, said Michael Osterholm, a University of Minnesota expert on infectious diseases.

“We don’t really have any understanding of what influenza virus will emerge one day to cause the next pandemic,” Osterholm said. “It sure isn’t this (bird flu strain), or it would be causing it (a pandemic) right now.”

The U.S. should maintain collaborations that train disease investigators in other countries to detect emerging infections, public health experts say.

“We have to continue to invest in surveillance in areas where we think these infectious agents are likely to emerge,” said Ian Lipkin, an infectious diseases researcher at New York’s Columbia University.

“I’m hoping that the Trump administration — as they are concerned about people coming across the border who may be infected with this or that or the other thing — will see the wisdom in trying to make sure that we do surveillance in areas where we think there’s a large risk,” he said.

The Biden administration has been pumping money out the door to fund bird flu preparedness programs before the Trump team takes over, leaving public health officials grateful even as they insist the incoming president will need to do more once he’s in office.

“This is a good down payment on funding for what is currently a limited number of human cases acquired directly from infected animals. It is not adequate funding for preparing for a potential pandemic,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

The Department of Health and Human Services announced in early January it would be awarding over $300 million in funding for bird flu response efforts, including $186 million through the Administration for Strategic Preparedness and Response for preparedness efforts like training for hospital staff, special units for infectious diseases and personal protective equipment stockpiles.

David Boucher, ASPR’s director of infectious disease preparedness and response, told NOTUS that the incoming Trump administration’s potential views on H5N1 were not considered when deciding which programs to allocate funds to and when. But he said that almost all of the recently announced funding has already been obligated to specific contracts and grants.

“Where we are focusing on the transition is to make sure that it’s smooth, so that our response to H5N1 carries through and we don’t have any disruptions,” he said. “We want a seamless transition to make sure that we’re giving the best response possible to the American public.”

The current H5N1 outbreak began in early 2024. Cases have been detected in wild birds, poultry and cattle — along with over 60 confirmed human cases, mostly in agricultural workers. One person with severe H5N1 died in early January.

A health care lobbyist, who asked to remain anonymous in order to remain on good terms with the incoming Trump administration, said public health advocacy groups involved in the bird flu response are waiting to see how HHS secretary nominee Robert F. Kennedy Jr. may influence public health policy. Kennedy has repeatedly implied that bird flu was created in a lab, potentially with the knowledge of the government, a theory that is not supported by evidence.

Kennedy and the Trump transition team did not respond to requests for comment.

“I think there’s a lot of question marks about the stance that the administration is going to take. [Trump’s first administration] obviously presided over a wildly successful program in Operation Warp Speed, but that has caused some friction within the Republican caucus and the Republican Party,” the lobbyist said. “It’s hard to know who will be calling the shots on the response and what they will want to do. So I think there’s definitely concern, but certainly hope that they will continue preparing in the same way that the Biden administration has.”

But New York State Health Commissioner James McDonald told NOTUS that the every-other-week phone calls he’s had with HHS throughout the current bird flu outbreaks aren’t currently scheduled to continue past Jan. 20.

“They’re waiting for the new administration to see what they want to do,” McDonald said.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a former member of HHS’ COVID-19 advisory committee, said that while the Biden funding was “a start,” it wasn’t enough. What the U.S. really needs to be prepared for a future pandemic, Osterholm said, is sustained investment in vaccine development and manufacturing — because once a serious outbreak actually starts, it’s already too late.

“When you have a pandemic begin, it’ll happen real fast, and it’s like falling off a cliff,” Osterholm said. “Imagine you’ve just walked miles and miles on a perfectly flat piece of ground, and then you take one more step and you’re 24 inches off the edge of the cliff, and it’s five miles straight down. That’s where we’re at. We don’t know how close we are to the edge of that cliff.”

But the U.S.’s vaccine manufacturing capacity is far below what would be needed to adequately protect the population should H5N1 become a widespread pandemic, Osterholm said — and the 60 million doses of antiviral drug Tamiflu the U.S. has stockpiled won’t be enough if H5N1 becomes widely transmitted between humans.

“That won’t stop transmission. At best, it will reduce serious illness and deaths, but it won’t stop the pandemic, and of course, it won’t even begin to address what’s happening globally,” Osterholm said.

The chances of the incoming administration making a large investment in vaccines may be slim. Kennedy, a longtime vaccine skeptic, has said he would give infectious disease research a “break.” And Trump has said he would support efforts by Kennedy to investigate if vaccines cause autism, a claim that has been debunked.

“I worry about the fact that a lot of people who will be in health decision making positions will be new to the job,” Nuzzo said. “We lost a lot of experienced people due to political attacks and general attrition during COVID-19.”

But regardless of staffing challenges, Nuzzo said she believes the incoming administration will be forced to act on H5N1 — if not because of the public health risk, then because of the threat it poses to the economy. Nuzzo pointed to egg shortages and the loss of income to dairy farmers as examples of H5N1’s economic impacts.

“For an administration that was elected in part because of the cost of grocery bills, I don’t see a scenario in which they can ignore H5N1 and still answer the political mill that is hoping for a safe, healthy and inexpensive food supply,” Nuzzo said.

—
Margaret Manto is a NOTUS reporter and an Allbritton Journalism Institute fellow.

Yesterday, health officials in Louisiana announced that a patient who was hospitalized with severe bird flu in December has died. The individual contracted bird flu after exposure to a backyard flock and wild birds. It is the first death recorded in the United States attributed to H5N1, or avian influenza.

The person was over the age of 65 and reportedly had underlying medical conditions. The Louisiana Health Department has not released any more details about the patient.

A total of 66 people in the US tested positive for bird flu in 2024, according to the Centers for Disease Control and Prevention. In all of the other cases, people developed mild symptoms and made a full recovery. But the Louisiana case is a stark reminder that avian flu can be dangerous. And as the number of human infections rises, health experts worry about more cases of severe illness—and potentially more deaths.

“This is an ongoing game of Russian roulette,” says physician Nahid Bhadelia, founding director of the Center on Emerging Infectious Diseases at Boston University. “The more virus there is in our environ
ment, the more chances there are for it to come into contact with humans.” It was only a matter of time before bird flu turned deadly, she says.

The US is in the middle of an H5N1 outbreak that shows no signs of stopping. The virus has infected more than 130 million birds, including commercial poultry, since January 2022. In April 2024 it spilled into dairy cows for the first time. Though not fatal for cows, the virus has sickened more than 900 dairy herds in 16 states.

Most people who come down with bird flu are farm workers or others who have direct contact with sick animals. Of the 66 confirmed infections in the US last year, 40 had exposure to dairy cows, while 23 had exposure to poultry and culling operations. In the three other cases, the exact source of exposure is unknown.

Since 2003, more than 850 human cases of H5N1 bird flu have been reported outside the United States, and about half of those have resulted in death. In a statement released Monday, the CDC said a death from H5N1 bird flu “is not unexpected because of the known potential for infection with these viruses to cause severe illness and death.” Federal health officials say the risk of getting bird flu remains low for the general public, and there is no evidence that the virus is spreading from person to person anywhere in the country.

One of the puzzling aspects of the current US outbreak is why all the human infections until now have resulted in mild illness. “It could be that they're young, healthy people,” says Jennifer Nuzzo, director of the Pandemic Center and a professor of epidemiology at Brown University. “It could be that the way they're being exposed is different from how we've historically seen people get infected. There are a number of hypotheses, but at this point they're all just guesses.”

Nuzzo says it’s very possible that the Louisiana patient’s preexisting health conditions contributed to the severity of their illness, but also points to the case of a teenager in Canada who was hospitalized with bird flu in November.

The 13-year-old girl was initially seen at an emergency department in British Columbia for a fever and conjunctivitis in both eyes. She was discharged home without treatment and later developed a cough, vomiting, and diarrhea. She wound up back in the emergency department in respiratory distress a few days later. She was admitted to the pediatric intensive care unit and went into respiratory failure but eventually recovered after treatment. According to a case report published in the New England Journal of Medicine, the girl had a history of mild asthma and an elevated body-mass index. It’s unknown how she caught the virus.

“What that tells us is that we have no idea who is going to develop mild illness and who is going to develop severe illness, and because of that we have to take these infections very seriously,” Nuzzo says. “We should not assume that all future infections will be mild.”

There’s another clue that could explain the severity of the Louisiana and British Columbia cases. Virus samples from both patients showed some similarities. For one, both were infected with the same subtype of H5N1 called D1.1, which is the same kind of virus found in wild birds and poultry. It’s different from the B3.13 subtype, which is dominant in dairy cows.

“Right now, the question is, is this a more severe strain than the dairy cattle strain?” says Benjamin Anderson, assistant professor of environmental and global health at the University of Florida. So far, scientists don’t have enough data to know for sure. A handful of poultry farm workers in Washington have tested positive for the D1.1 subtype, but those individuals had mild symptoms and did not require hospitalization.

“In the case of the Louisiana infection, we know that person had comorbidities. We know that person was an older individual. These are factors that contribute to more severe outcomes already when it comes to respiratory infections,” Anderson says.

In the Louisiana and British Columbia cases, there’s evidence that the virus may have evolved in both patients to produce more severe illness.

A CDC report from late December found genetic mutations in the virus taken from the Louisiana patient that may have allowed it to enhance its ability to infect the upper airways of humans. The report says the changes observed were likely generated by replication of the virus throughout the patient’s illness rather than transmitted at the time of infection, meaning that the mutations weren’t present in the birds the person was exposed to.

Writing in the New England Journal of Medicine, the team that cared for the Canadian teen also described “worrisome” mutations found in her viral samples. These changes could have allowed the virus to more easily bind to and enter cells in the human respiratory tract.

In the past, bird flu has rarely been transmitted from person to person, but scientists worry about a scenario where the virus would acquire mutations that would make human transmission more likely.

For now, people who work with birds, poultry, or cows, or have recreational exposure to them, are at higher risk of getting bird flu. To prevent illness, health officials recommend avoiding direct contact with wild birds and other animals infected with or suspected to be infected with bird flu viruses.

Emily Mullin is a staff writer at WIRED, covering biotechnology. Previously, she was an MIT Knight Science Journalism project fellow and a staff writer covering biotechnology at Medium's OneZero. Before that, she served as an associate editor at MIT Technology Review, where she wrote about biomedicine. Her stories have also... Read more

Bird flu continues to spread widely in cattle and wild birds. What challenges does the incoming Trump administration face in tackling the outbreak and preparing for a possible pandemic?

The first confirmed death from the H5N1 bird flu in the U.S., reported Monday by officials in Louisiana, comes amid growing concerns that the world could be stumbling into another pandemic.

The bad news around the H5N1 outbreak has been mounting: Nearly a thousand U.S. dairy herds infected since last March, nearly 20 million domestic poultry destroyed due to infections in December, 66 human infections in the U.S., and now one death.

The...

ADDS Louisiana and UK researcher quotes, details

The first human death from bird flu in the United States has intensified calls for the government to ramp up efforts to stave off the threat of another pandemic -- particularly ahead of Donald Trump's return to the White House.

Health experts around the world have for months been urging US authorities to increase surveillance and share more information about its bird flu outbreak after the virus started spreading among dairy cows for the first time.

On Monday, Louisiana health authorities reported that a patient aged over 60 was the country's first person to die from bird flu.

The patient, who contracted avian influenza after being exposed to infected birds, had underlying medical conditions, US health authorities said.

The World Health Organization has maintained that bird flu's risk to the general population is low, and there is no evidence that it has been transmitted between people.

However health experts have been sounding the alarm about the potential pandemic threat of bird flu, particularly as it has shown signs of mutating in mammals into a form that could spread more easily among humans.

The avian influenza variant H5N1 was first detected in 1996, but a record global outbreak since 2020 has resulted in hundreds of millions of poultry birds being culled -- and killed an unknown but massive number of wild birds.

In March, the virus started transmitting between dairy cows in the United States.

Since the start of last year, 66 bird flu cases have been recorded in humans in the United States, many of them among farm workers, according to the Centers for Disease Control and Prevention.

The US cases had been relatively mild until the Louisiana patient, though a Canadian teenager become severely ill. Nearly half of the 954 human cases of H5N1 recorded since 2003 have been fatal, according to the WHO.

Marion Koopmans, a virologist at the Erasmus University Medical Center in the Netherlands, emphasised that the public should not be unduly worried about another pandemic.

"The problem is that this is how it could start," she added.

Koopmans criticised that "there is not really an effort to contain" the bird flu outbreak among cattle in the United States.

Tom Peacock, a virologist at the Imperial College London, said he thought "the biggest error the US has made is its slow and weak response to the cattle outbreak".

The reason bird flu was affecting US cattle seemed to be a combination of this weak early response, poor biosecurity, "and the intensification of US dairy farming (which involves far more movement of animals than any European system)," he told AFP.

Peacock was a co-author of a preprint study released on Monday, which has not been peer-reviewed, describing how the mutations of H5N1 in cattle enhance its ability to infect other mammals -- including humans.

Rebecca Christofferson, a scientist at Louisiana State University, said there were signs that the deceased patient's virus mutated while they were infected -- but it was not transmitted to anyone else.

"The worry is, the more you let this sort of run wild... the more chances you have for this sort of mutation to not only occur, but to then get out and infect someone else, then you start a chain reaction," she told AFP.

WHO spokeswoman Margaret Harris said the United States "are doing a lot of surveillance" on bird flu. "That's why we're hearing about it," she added.

Last week, the US government awarded an additional $306 million to bolster H5N1 surveillance programs and research.

Peacock said that monitoring has increased for US cattle but warned "big gaps" remain.

Rick Bright, a former top US health official, has been among those calling for the department of agriculture to release more information about bird flu infections among animals.

"There are still just reams of data from this current administration that haven't been released," he told the Washington Post on Monday.

The United States has a stockpile of millions of H5N1 vaccine doses, which Bright said should be offered to at-risk people such as farm workers.

The Biden government has also been urged to encourage companies to develop rapid home tests as well as monitor wastewater for bird flu.

Several of the experts called on Biden to act quickly, before president-elect Trump replaces him in less than two weeks.

There are particular concerns about Trump's pick for health secretary, Robert F. Kennedy Jr.

Kennedy is a sceptic of vaccines, which would be among the most powerful weapons to fend off a potential new pandemic. He is also a known fan of raw milk, which has repeatedly been found to be contaminated with bird flu from infected dairy cows.

People at home have been advised to avoid infected animals -- and raw milk -- and to get a seasonal flu vaccine.

Christofferson said her "biggest worry" was that if someone was infected with both seasonal flu and H5N1, they could mix to become "something that's either more transmissible and or more dangerous to people".

The Barron's news department was not involved in the creation of the content above. This article was produced by AFP. For more information go to AFP.com.
© Agence France-Presse

NEW YORK (AP) — The first U.S. bird flu death has been reported — a person in Louisiana who had been hospitalized with severe respiratory symptoms.

State health officials announced the death on Monday, and the Centers for Disease Control and Prevention confirmed it was the nation’s first due to bird flu.

Health officials have said the person was older than 65, had underlying medical problems and had been in contact with sick and dead birds in a backyard flock. They also said a genetic analysis had suggested the bird flu virus had mutated inside the patient, which could have led to the more severe illness.

Few other details about the person have been disclosed.

Since March, 66 confirmed bird flu infections have been reported in the U.S., but previous illnesses have been mild and most have been detected among farmworkers exposed to sick poultry or dairy cows.

A bird flu death was not unexpected, virus experts said. There have been more than 950 confirmed bird flu infections globally since 2003, and more than 460 of those people died, according to the World Health Organization.

The bird flu virus “is a serious threat and it has historically been a deadly virus,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. “This is just a tragic reminder of that.”

Nuzzo noted a Canadian teen became severely ill after being infected recently. Researchers are still trying to gauge the dangers of the current version of the virus and determine what causes it to hit some people harder than others, she said.


“Just because we have seen mild cases does not mean future cases will continue to be mild,” she added.

In a statement, CDC officials described the Louisiana death as tragic but also said “there are no concerning virologic changes actively spreading in wild birds, poultry or cows that would raise the risk to human health.”

In two of the recent U.S. cases — an adult in Missouri and a child in California — health officials have not determined how they caught the virus. The origin of the Louisiana person’s infection was not considered a mystery. But it was the first human case in the U.S. linked to exposure to backyard birds, according to the CDC.

Louisiana officials say they are not aware of any other cases in their state, and U.S. officials have said they do not have any evidence that the virus is spreading from person to person.

The H5N1 bird flu has been spreading widely among wild birds, poultry, cows and other animals. Its growing presence in the environment increases the chances that people will be exposed, and potentially catch it, officials have said.

Officials continue to urge people who have contact with sick or dead birds to take precautions, including wearing respiratory and eye protection and gloves when handling poultry.

___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The patient, aged over 65, had been hospitalized in the southern state since at least mid-December, when the US Centers for Disease Control and Prevention (CDC) announced it as the country's first serious case of human infection from the H5N1 virus.

"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk," the Louisiana Department of Health said in a statement announcing the death.

It said the patient had "contracted H5N1 after exposure to a combination of a non-commercial backyard flock and wild birds," but had detected no further H5N1 infections nor evidence of person-to-person transmission in the state.

The news comes just days after the federal government awarded an additional $306 million to bolster H5N1 surveillance programs and research, amid some criticism for President Joe Biden's administration over its response to the simmering issue.

The amount of bird flu circulating among animals and humans has alarmed scientists over concerns it could mutate into a more transmissible form -- potentially triggering a deadly pandemic.

Since the beginning the 2024, the CDC has recorded 66 cases of bird flu in humans in the United States.

"We have a lot of data that shows that this virus can be lethal, more lethal than many viruses we worry about," Jennifer Nuzzo, a professor of epidemiology at Brown University, told AFP.

"For that reason, people have been quite alarmed about these outbreaks that have been occurring on farms and other places in the US and have really been shouting for the US government to do more," she said.

Death 'not unexpected'
The CDC said in December that genetic sequencing of the H5N1 virus from the Louisiana patient was different from the version detected in many dairy herds around the country.

And a small part of the virus in the patient had genetic modifications that suggested it could have mutated inside the body to adapt to the human respiratory tract.

However, such mutations are not the only thing that could make the virus more contagious or transmissible between humans, according to researchers interviewed by AFP.

H5N1 was first detected in 1996, but since 2020, the number of outbreaks among bird flocks has exploded, while a growing number of mammal species have been affected.

"While tragic, a death from H5N1 bird flu in the United States is not unexpected because of the known potential for infection with these viruses to cause severe illness and death," the CDC said in a statement.

The World Health Organization has recorded over 950 bird flu cases in humans since 2003 in 24 countries, including a large number in China and Vietnam.

Nuzzo said the announcement of the US death did not change her perspective, but underscored her "big worry about the relatively unchecked spread of this virus and the urgency of doing more to prevent people from being infected."

"This is a nasty virus that no one wants to get," she said.

The U.S. has recorded its first death of a person infected with bird flu.

The patient was a resident of southwest Louisiana who was hospitalized last month with the first known severe case of bird flu in the country.

On Monday, the Louisiana Department of Health said the person had died from the illness but shared few other details because of patient privacy rules.

The patient was over 65 and had underlying medical conditions.

The patient contracted the illness after being exposed to "a combination of a non-commercial backyard flock and wild birds," according to a news release. An "extensive public health investigation" did not turn up any other cases of H5N1 in a person or evidence of human-to-human spread.

More than 65 people have caught bird flu during the current outbreak, primarily from close contact while working with infected dairy cattle or poultry.

While these cases have largely led to mild illness, historically other strains of bird flu have proved quite deadly in humans. Of the more than 950 cases reported to the World Health Organization, about 50% have resulted in death.

"We have 20-plus years of data showing that it's a pretty nasty virus," said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. "I am not counting on future infections all being mild."

In November, a 13-year-old girl in British Columbia, Canada, was hospitalized with bird flu. How she caught the virus isn't clear. But her illness was so serious she required extracorporeal membrane oxygenation (ECMO) to keep her alive.

That case underscores that it's "very difficult to predict who will become severely ill after an infection," said Nuzzo. "We should not discount this latest death in Louisiana because the patient had underlying health conditions."

Genetic sequencing from the Centers for Disease Control and Prevention indicates the H5N1 virus responsible for both of these severe illnesses belongs to the D1.1 genotype. While this is a different genetic lineage from the virus infecting dairy cattle, it's still part of the same strain circulating globally in wild birds and U.S. dairy herds — technically known as clade 2.3.4.4b.

The virus appears to have picked up some worrisome mutations during the course of the Louisiana patient's illness.

The same may have happened in Canada. In both cases, there's no indication others were infected, though.

In a statement on the Louisiana death, the CDC reiterated that the risk to the general public is still considered low, saying there are no "concerning virologic changes actively spreading in wild birds, poultry, or cows that would raise the risk to human health."

The outbreak in dairy cattle recently led California to declare a state of emergency and kept public health officials on edge because of the increased potential for the virus to spill over into humans.

Their advice is to avoid contact with wild birds, poultry and rodents and to wash your hands after touching feces or objects that could be contaminated with saliva or mucus, such as bird feeders.

Pets can also catch the virus, particularly by consuming raw meat or raw milk, which can also harbor high loads of the virus.

Edited by Jane Greenhalgh

An uptick of a routine virus in China ignited dire headlines and social media posts, but public health experts caution that the human metapneumovirus cases are part of the typical ebb and flow of respiratory virus seasons and are no reason to be alarmed.

Chinese authorities in late December reported a rising rate of children ages 14 and under testing positive for human metapneumovirus, or HMPV, as part of a broader update on the respiratory virus season. Videos posted on social media of crowded hospitals prompted speculation about the start of another global outbreak.

But respiratory diseases in China this season appear less severe and are spreading at a smaller scale compared with last year, Foreign Ministry spokeswoman Mao Ning said Friday. Public health experts and officials in the United States shared similar assessments that the situation in China does not appear unusual.

The discourse surrounding HMPV illustrates how perceptions of infectious-disease threats have become skewed in the aftermath of covid — particularly when images of sick people emerge from China. Viruses well known among infectious-disease experts but obscure to the public now attract outsize attention.

The HMPV worries are reminiscent of panic last winter over childhood pneumonia cases in China caused by the common Mycoplasma pneumoniae bacterium that periodically spike in countries. Public health experts said those concerns, including a call for a travel ban, were also overblown.

"There's just this tendency post-covid to treat every infectious-disease anything as an emergency when it's not," said Amesh Adalja, an infectious-diseases physician and senior scholar at the Johns Hopkins Center for Health Security. "You wouldn't probably be calling me in 2018 about this."

What is HMPV?
HMPV is nowhere close to SARS-CoV-2 (the virus that causes covid-19) or pandemic material. It's among the long-standing, usually anonymous viruses that cause cold- or flu-like symptoms in the winter.

"How many times do you get sick in the winter and you have no idea what you've got?" said Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health. "It's a virus you'll get. You'll probably get it multiple times in your life."

HMPV has zoonotic origins spilling over from an avian species centuries ago before it was discovered in the Netherlands in 2001. It is part of the same pneumoviridae family as respiratory syncytial virus (RSV), which often infects young children and sparks outbreaks at day cares.

Andrew Pavia, chief of the division of pediatric infectious diseases at University of Utah Health, said HMPV behaves similarly to RSV, with caseloads more severe some years than others. It can put strain on hospitals, especially when coinciding with upticks of covid, flu and RSV.

Why are health experts not too worried about HMPV in China?
Kevin Griffis, a spokesman for the U.S. Centers for Disease Control and Prevention, said the agency is monitoring the outbreak in China but does not think it is novel, and that most respiratory virus hospitalizations are caused by influenza A.

In the United States, less than 2 percent of patients tested for respiratory viruses in late December had HMPV, which ranked last among the usual culprits, according to CDC data.

China underwent one of the world's most restrictive and prolonged lockdowns in response to covid, reducing people's exposure to other viruses such as HMPV. That created a situation where people became more susceptible during a surge, experts said, leading to unusual cases even in young and middle-aged adults.

"Even though you say it's typically affecting the very young and very old, it doesn't mean exclusively," Nuzzo said. "When you have a lot of people getting sick at once, you see things you may not see when it's spread out over time."

Nuzzo said she has not heard reports of unusually large numbers of hospitalizations and deaths in otherwise healthy young and middle-aged adults that would raise alarms, as clinicians in China did during the early days of covid.

Improved testing and disease surveillance have also made it easier to spot upticks in HMPV that would have gone unnoticed years ago.

"People don't realize that metapneumovirus virus is just one of those cadre of viruses that causes upper respiratory infections and has been doing so for a very long time. We're just getting better about testing it and naming it," said Adalja, the infectious-diseases physician. "That can sometimes lead to stories that can be sensationalistic."

What are the symptoms and treatment?
Just because a virus is routine doesn't mean it's mundane. Like other respiratory viruses, HMPV can progress to more serious symptoms, including pneumonia, and poses elevated risk to young children, older adults and immunocompromised people.

But most cases remain mild, with symptoms such as cough, fever and nasal congestion.

There is no vaccine or antiviral treatment for HMPV. Doctors and public health authorities offer no special advice for preventing HMPV: It's the usual mix of washing your hands, covering your mouth when sneezing, and avoiding sick people.

"This is typically less severe than flu or covid. It's basically like the common cold," said Katelyn Jetelina, a California epidemiologist who writes a weekly newsletter on infectious diseases. "There's very little people can do about it. There's no drugs, there's no vaccine. Masking probably works like it does with the other viruses. But that's about it."

Lena H. Sun contributed to this report.

Word count: 884
Copyright WP Company LLC d/b/a The Washington Post Jan 6, 2025

The victim was older than 65 years and had preexisting health conditions, according to Louisiana authorities, and was believed to have handled wild birds.
There is no evidence yet that the virus has acquired the ability to transmit between people.
A Louisiana resident infected by H5N1 bird flu has died, state authorities there reported Monday, marking the first U.S. death from the disease.

The patient, a person older than 65 years with preexisting conditions, is believed to have handled infected noncommercial and wild birds with the virus, according to the Louisiana Department of Public Health. The person’s name and gender were not disclosed.

The news has confirmed what many experts fear: That if left to spread unabated, the disease has the potential to cause severe illness and death.

“This is an unfortunate reminder that H5N1 retains the ability to cause severe illness and death. It would be wrong to be reassured by the fact that the patient had underlying health conditions,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I.

Nuzzo noted that a child in Canada was also critically sickened by the virus but ultimately survived. However, the lengths doctors took to keep the child alive — daily blood transfusions, intubation and extracorporeal membrane oxygenation, a life support technique that temporarily takes over the function of the heart and lungs for patients with severe heart or lung condition — highlight the extraordinary severity of disease the virus is capable of delivering.

“For this reason, we must treat all infections seriously, and work harder to prevent them,” Nuzzo said.

Before H5N1 bird flu virus arrived in North America in 2021, the disease had been recognized as having potential to cause severe disease and death.

...

Jan 6 (Reuters) - A U.S. patient who had been hospitalized with H5N1 bird flu has died, the Louisiana Department of Health said on Monday, marking the country's first reported human death from the virus.
The patient, who has not been identified, was hospitalized with the virus on Dec. 18 after exposure to a combination of backyard chickens and wild birds, Louisiana health officials had said.
The patient was over age 65 and had underlying medical conditions, officials said, putting the patient at higher risk for serious disease.

Nearly 70 people in the U.S. have contracted bird flu since April, most of them farmworkers, as the virus has circulated among poultry flocks and dairy herds, according to the U.S. Centers for Disease Control and Prevention.
Federal and state officials have said the risk to the general public remains low.
The ongoing bird flu outbreak, which began in poultry in 2022, has killed nearly 130 million wild and domestic poultry and has sickened 917 dairy herds, according to the CDC and the U.S. Department of Agriculture.

An analysis of the virus taken from the Louisiana patient showed it belongs to the D1.1 genotype - the same type that has recently been detected in wild birds and poultry in Washington State, as well as a recent severe case in a teen in British Columbia, Canada, according to the CDC.
It is different from the B3.13 genotype currently circulating in U.S. dairy cows, which has mostly been associated with mild symptoms in human cases including conjunctivitis, or pink eye.

The CDC said the risk to the general public remains low. Experts have been looking for signs that the virus is acquiring the ability to spread easily from person to person, but the CDC said there is no evidence of that.
People who work with birds, poultry, cows, or have recreational exposure to them, are at higher risk, Louisiana health officials said in a statement.
Worldwide, more than 950 human cases of bird flu have been reported to the World Health Organization, and about half have resulted in death.

"Though H5N1 cases in the U.S. have been uniformly mild, the virus does have the capacity to cause severe disease and death in certain cases," said Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.
Several experts said the death was concerning, but not surprising.
"This is a tragic reminder of what experts have been screaming for months, H5N1 is a deadly virus," said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University's School of Public Health.
"I hate to have the death of somebody be a wake-up call," said Gail Hansen, a veterinary and public health consultant.
"But if that's what it takes, hopefully that will make people look at bird flu a little more carefully and say this really is a public health issue we need to be looking at more closely."
Keep up with the latest medical breakthroughs and healthcare trends with the Reuters Health Rounds newsletter. Sign up here.
Reporting by Jasper Ward, Katharine Jackson, and Leah Douglas in Washington and Tom Polansek and Julie Steenhuysen in Chicago; editing by Timothy Gardner and Bill Berkrot

As concern grows over the bird flu outbreak in the U.S., the Biden administration is accelerating its efforts to watch and prepare for a potential pandemic.

The Department of Health and Human Services on Friday announced $306 million in new funding for avian flu preparedness, a third of it earmarked for increased monitoring and testing of farmworkers. Most of the rest will go to regional, state, and local programs aimed at preparing for a bird flu pandemic.

Public-health experts have been highly critical of the federal and state response to the bird flu, which was first identified in cows in the U.S. early in 2024. They say the government should have been far more aggressive in monitoring and trying to control the spread of the virus.

"I'm glad to see they're taking more effort," said Jennifer Nuzzo, a professor of epidemiology at Brown University and director of the school's Pandemic Center. "Inasmuch as it signals that this is a serious threat and we need to treat it seriously, I think that's important."

The announcement comes just over two weeks before the Trump administration arrives in Washington. It is the latest in a series of 11th-hour efforts by Biden officials to quickly ramp up their response to the outbreak, which has sickened cattle, poultry, and an increasing number of people across the U.S.

Two weeks ago, the Department of Agriculture said it would begin nationwide testing of unprocessed milk to track the H5N1 avian flu virus. Experts had called for them to do that at least since April.

Though the Centers for Disease Control and Prevention continues to say that the threat the virus poses to the general public is low, there have been a number of worrying developments in recent weeks.

In mid-December, the CDC said that a person had been hospitalized in Louisiana with the first serious case of bird flu in the U.S., a month after officials in Canada reported a serious case there . Later, the CDC said that an analysis of swabs from the Louisiana patient found changes in the virus that could help it bind to human cells .

Those changes likely happened as the virus replicated in the Louisiana patient, according to the CDC. That patient hasn't passed the virus to anyone else, the agency has said.

But the identification of the mutated virus serves as a reminder of how quickly influenza viruses can change, and how avian flu could eventually pose a serious challenge to human health.

The newly-announced HHS awards include $90 million to the Hospital Preparedness Program, an initiative within HHS's Administration for Strategic Preparedness and Response that provides funding to help hospitals respond to major emergencies and disasters. ASPR's Regional Emerging Special Pathogen Treatment Centers, which are hospitals designated to care for patients with very infectious diseases, will get $26 million.

The funds also include $10 million for the National Disaster Medical System, an ASPR program that sends medical personnel and supplies to states in an emergency. The largest individual award is $103 million for CDC to give to local jurisdictions for increased monitoring of people exposed to infected animals.

The funding announced Friday comes after earlier allocations by HHS and the USDA, including $101 million in funding HHS announced in May. HHS said in June that it committed $176 million in funding to Moderna to develop an mRNA-based pandemic flu vaccine .

So far, the government efforts have done little to stop the spread of the virus. The USDA has confirmed cases of H5N1 in 915 dairy herds across the U.S., nearly 200 in California in the last 30 days alone. The virus has ripped through more than two-thirds of California dairy farms since August , and experts say the government's explanation for how it has spread is unconvincing.

The CDC, meanwhile, has confirmed 66 human infections, half of them in California.

"While the risk to humans remains low, we are always preparing for any possible scenario that could arise," HHS Secretary Xavier Becerra said in a statement on Friday. "Preparedness is the key to keeping Americans healthy and our country safe."

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

By Josh Nathan-Kazis

Most human cases of bird flu in North America have been mild, a fact that’s underscored by a new study of the first 46 confirmed human H5N1 infections in the United States this year. But the case of an ill Canadian teen stands out because of its severity and because the source of exposure remains a mystery.

With the number of cases continuing to grow, leaders from the National Institutes of Health are calling for more action to tackle the bird flu outbreak.

The teenager, who was hospitalized with H5N1 infection in November, became critically ill and spent almost two weeks hooked up to machines that took over for her failing heart, lungs and kidneys, according to a report published Tuesday in the New England Journal of Medicine.


The 13-year-old had asthma and obesity but was otherwise in good health before catching H5N1. She recovered after aggressive treatment with a combination of three antiviral drugs, according to the report.

“She had multiorgan failure and was horribly ill,” said Dr. Megan Ranney, an emergency medicine physician and dean of the Yale School of Public Health, who was not involved with the girl’s care.

The teen was treated with extracorporeal membrane oxygenation, or ECMO, in which machines take over the work of the heart and lungs to give the body a chance to recover. She also had continuous dialysis to help remove toxins from her blood because her kidneys weren’t working, as well as plasma exchange, in which machines separate the clear part of the blood from blood cells so harmful substances can be removed.

“Were those extraordinary treatment modalities not available, she likely would not have lived,” Ranney said.

Health officials in British Columbia closed their investigation into the case late last month after being unable to find the virus in any of the household pets, nearby animals, or soil or water samples. Close monitoring of people who were around the teen determined that no one else caught the virus from her. At the time, it wasn’t clear whether she had recovered.

The new report on the teen’s case “clearly shows that a child who was otherwise generally healthy became sick and then got very, very ill in a matter of days. This is a very worrisome outcome that we should be much more concerned about happening with other infections,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University. She was not involved in the case.

The teen was infected with a newer variant of the H5N1 virus, D1.1, which is carried by wild birds. This variant has played a role in some infections of poultry workers in Washington, which were mild, and a recent human infection in Louisiana, which was severe.

In both severe infections – the teen’s and the case in Louisiana – the virus has shown changes that mean it might be adapting to humans, a finding that has put infectious disease experts on high alert since it increases the possibility of human-to-human spread.

“For this reason, we should be much more aggressive in conducting environmental surveillance for H5N1 to track the virus and to prevent people from becoming infected,” Nuzzo said.

The report of the first 46 human cases, also published Tuesday in the New England Journal of Medicine by researchers at the US Centers for Disease Control and Prevention, shows that most were exposed to infected animals or to raw milk.

Eye redness, or conjunctivitis, was the most common symptom in these farmworker infections, showing up in 42 of 46 cases (93%). Almost half of the workers had fevers, and more than a third reported respiratory symptoms. The average duration of illness was about four days.

The article also acknowledges that the official number of cases is an undercount. Although the CDC says there have been 66 confirmed cases in the US this year, recent testing on dairy farms found that 7% of workers had evidence of recent H5N1 infection in their blood.

In a commentary that accompanied the two studies, Dr. Jeanne Marrazzo, who directs the National Institute of Allergy and Infectious Diseases, says the mutations found in the virus isolated from the Canadian teen highlight an “urgent need for vigilant surveillance and assessment of the threat of human-to-human transmission.”

Surveillance has been hampered because of incomplete reporting of animal infections, she wrote. The US Department of Agriculture hasn’t been submitting critical details like the exact dates when animals have gotten sick or precise locations that help scientists track the evolution of a virus over time.

Taken together, she writes, the new reports of human cases show that the pace of human H5N1 infections has been accelerating. There have also been an increasing number of people with respiratory symptoms, like breathing problems or coughing, linked to their infections.

Although the overall number of human infections related to H5N1 has been low, the continued drip, drip, drip of human and animal detections is not a good sign.

“This kind of repetitive, persistent opportunity for passage from one species to another, from one anatomic space to another, that’s what that’s what influenza thrives on to mutate,” Marrazzo told CNN. “This virus doesn’t miss a beat.”

She and co-author Dr. Michael Ison, who is chief of the Respiratory Diseases Branch at NIAID, call for better cooperation between human and animal disease investigators, complete reporting of data from animal infections so scientists can better track how the virus is spreading, development of countermeasures like vaccines and antiviral medication, and more precautions to prevent infection, such as increased use of recommended personal protective equipment and education about the risks of being around sick animals.

“The risk is really going to come when this gets better at obviously infecting humans, and then we are faced with potential for human-to-human transmission,” Marrazzo said.

The fate of a Canadian teenager who was infected with H5N1 bird flu in early November, and subsequently admitted to an intensive care unit, has finally been revealed: She has fully recovered.

But genetic analysis of the virus that infected her body showed ominous mutations that researchers suggest potentially allowed it to target human cells more easily and cause severe disease — a development the study authors called “worrisome.”

The case was published Tuesday in a special edition of the New England Journal of Medicine that explored H5N1 cases from 2024 in North America. In one study, doctors and researchers who worked with the Canadian teenager published their findings. In the other, public health officials from across the U.S. — from the Centers for Disease Control and Prevention, as well as state and local health departments — chronicled the 46 human cases that occurred between March and October.

There have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024.

In the case of the 13-year-old Canadian child, the girl was admitted to a local emergency room on Nov. 4 having suffered from two days of conjunctivitis (pink eye) in both eyes and one day of fever. The child, who had a history of asthma, an elevated body-mass index and Class 2 obesity, was discharged that day with no treatment.

Over the next three days, she developed a cough and diarrhea and began vomiting. She was taken back to the ER on Nov. 7 in respiratory distress and with a condition called hemodynamic instability, in which her body was unable to maintain consistent blood flow and pressure. She was admitted to the hospital.

On Nov. 8, she was transferred to a pediatric intensive care unit at another hospital with respiratory failure, pneumonia in her left lower lung, acute kidney injury, thrombocytopenia (low platelet numbers) and leukopenia (low white blood cell count).

She tested negative for the predominant human seasonal influenza viruses — but had a high viral loads of influenza A, which includes the major human seasonal flu viruses, as well as H5N1 bird flu. This finding prompted her caregivers to test for bird flu; she tested positive.

As the disease progressed over the next few days, she was intubated and put on extracorporeal membrane oxygenation (ECMO) — a life support technique that temporarily takes over the function of the heart and lungs for patients with severe heart or lung conditions.

She was also treated with three antiviral medications, including oseltamivir (brand name Tamiflu), amantadine (Gocovri) and baloxavir (Xofluza).

Because of concerns about the potential for a cytokine storm — a potentially lethal condition in which the body releases too many inflammatory molecules — she was put on a daily regimen of plasma exchange therapy, in which the patient’s plasma is removed in exchange for donated, health plasma.

As the days went by, her viral load began to decrease; on Nov. 16, eight days after she’d been admitted, she tested negative for the virus.

The authors of the report noted, however, that the viral load remained consistently higher in her lower lungs than in her upper respiratory tract — suggesting that the disease may manifest in places not currently tested for it (like the lower lungs) even as it disappears from those that are tested (like the mouth and nose).

She fully recovered and was discharged sometime after Nov. 28, when her intubation tube was removed.

Genetic sequencing of the virus circulating in the teenager showed it was similar to the one circulating in wild birds, the D1.1 version. It’s a type of H5N1 bird flu that is related, but distinct, from the type circulating in dairy cows and is responsible for the vast majority of human cases reported in the U.S. — most of which were acquired via dairy cows or commercial poultry. This is also the same version of the virus found in a Louisiana patient who experienced severe disease, and it showed a few mutations that researchers say increases the virus’ ability to replicate in human cells.

In the Louisiana case, researchers from the CDC suggested the mutations arose as it replicated in the patient and were were not likely present in the wild.

Irrespective of where and when they occurred, said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I., “it is worrisome because it indicates that the virus can change in a person and possibly cause a greater severity of symptoms than initial infection.”

In addition, said Nuzzo — who was not involved in the research — while there’s evidence these mutations occurred after the patients were infected, and therefore not circulating in the environment “it increases worries that some people may experience more severe infection than other people. Bottom line is that this is not a good virus to get.”

(This article originally appeared in Harvard Public Health magazine. Subscribe to their newsletter.)

Can we predict the ebb and flow of infectious disease the way meteorologists predict the weather?

The federal government has bet big on the concept with a new nationwide network called Insight Net, which links academic disease modelers with public health practitioners. The network comprises 13 research consortia with participants in 24 states and is funded with up to $262 million from the Centers for Disease Control and Prevention. Insight Net members are piloting analytical techniques that combine novel data sources to guide surveillance and inform decision-making during outbreaks. The end goal is to create something akin to a National Weather Service for disease.

Such capacity would be a game-changer for state and local health authorities and for hospitals. At the height of the Covid-19 pandemic, “we were not good at forecasting the demand,” says Douglas Sawyer, chief academic officer of MaineHealth, that state’s biggest hospital system. “We didn’t steer the ship, so to speak, with high fidelity as we wish we could have. We couldn’t prepare and shift resources in thoughtful ways.”

Many hospitals struggled with the crush of patients who needed intensive, isolated care. Because hospitals could not accurately predict the size of impending infection waves, many delayed or canceled routine health care such as physicals or cancer screenings. Meanwhile, Covid care sites built or converted by federal and state authorities ended up being largely unneeded.

These forecasting issues had serious financial consequences for hospitals—and serious health consequences for the public. Insight Net’s progress toward closing that information gap has been steady and marked by small but important victories—as well as plenty of reminders that even the best forecasts are only as good as the data that feed them.

By linking people working in public health directly with disease modelers, the CDC aims to fix the ad hoc approach it used for pandemic forecasting, which was panned from almost the start. In the summer of 2020, a critique in Foreign Affairs labeled the CDC’s approach “an arbitrary assortment of academics” reacting on the fly and asserted no one today would handle hurricane response in that fashion. In 2021, the CDC tapped Caitlin Rivers, one of the article’s coauthors and an epidemiologist at Johns Hopkins Bloomberg School of Public Health, as the first associate director of its new Center for Forecasting and Outbreak Analytics, or CFA. In 2023 the CFA established Insight Net, and Rivers, who had returned to Johns Hopkins, became director of its node in the network (Dylan George, her Foreign Affairs coauthor, is the CFA’s current director). Their core message, then and now: Disease forecasting shouldn’t be improvised.

Policymakers and the public put their trust in major storm alerts, according to George, because the weather service is “applying the best models in an operational context on a day in and day out basis, cranking out results,” George says. “And then you have local meteorologists interpret those results for people to actually make decisions.” That process establishes a track record of monitoring and communicating forecasts, including their uncertainty, even when the weather is calm, sunny, and mild. “We’ve tried to pattern after that,” George adds.

At the height of the Covid-19 pandemic, “we were not good at forecasting the demand.”

That has meant investing in a dedicated program for disease forecasting, with formal working relationships between modelers and federal, state, and local health officials. It also means the CFA has been keen to demonstrate how modeling can help public health practice and communication. For instance, it has tapped data from the National Wastewater Surveillance System, launched by the CDC in 2020, to improve localized forecasts of Covid hospital admissions. It also helped the Chicago Department of Public Health confront a March 2024 measles outbreak at a temporary migrant shelter housing more than 1,400 people. As public health workers began vaccinating and screening shelter residents to identify and isolate the sick, department leaders reached out to the CFA, which rapidly refined a model of measles to mimic the outbreak’s timeline of infection, symptom onset, and recovery, which Chicago health officials could then use to predict its future course.

The model didn’t influence the department’s interventions, which were already underway. But it did reassure officials they’d correctly identified their patient zero: Outbreak simulations that assumed earlier, undetected infections generated far different case data from what was observed. The forecasts also helped set expectations for the outbreak’s severity by providing a range of potential case numbers and dates when infections would peak and subside. After a couple weeks of continuous updating with data on new measles cases, the model predicted there would be between 57 and 65 cases and the final rash would appear on April 16. In the end, the outbreak lasted about two months and infected 57 people.

“It really helped our own planning, and our thinking about staffing,” says Stephanie Gretsch, an epidemiologist at the Chicago Department of Public Health. “It was also incredibly helpful for communicating with our city agency partners responsible for housing and schooling; and the hospitals we asked to help isolate infected residents, to give them a sense of how long we thought this was going to last.”

After the outbreak, Chicago public health officials used the modeling to quantify the value of its interventions. Outbreak simulations where responses did not include mass vaccination or active case-finding efforts suggested it would have lasted seven weeks longer and more than quadrupled the number of infections. This finding suggests that modeling hypothetical scenarios might offer a tool for easing heightened skepticism of public health interventions and investments, say several Insight Net partners.

Syphilis is one target of the Insight Net consortium at the University of Utah. The disease, resurgent in the U.S., can infect a fetus during pregnancy and cause serious medical complications, including miscarriage, stillbirth, and infant death. The goal is to “address the issues and show how bad this problem could get if trends continue,” says principal investigator Matthew Samore, a professor of medicine and the division chief of epidemiology at the University of Utah. “We also want to get a deeper understanding of how STIs like this are spreading through different populations…and to calculate how much benefit do we get by investing in more intensive screening and contact tracing.” By helping establish the extent of the risk, the models could bolster requests to fund more screening and treatment of groups with high infection rates, such as people in prison.

Modeling hypothetical scenarios might offer a tool for easing heightened skepticism of public health interventions and investments, say several Insight Net partners.

The modeling could also improve disease forecasting dashboards used by the public to assess health threats. The Massachusetts Department of Public Health, or MDPH, has dashboards that track severe respiratory illnesses statewide, but delays in data reporting from local hospitals limit their usefulness. In 2024, MDPH worked with the Insight Net researchers at the University of Massachusetts Amherst and the University of Texas at Austin to build models filling in those gaps, allowing it to add recent emergency room visits and hospital admissions due to Covid, RSV, and influenza broken down by demographics. Such small-scale adoptions are needed both to validate disease forecasting and to build trust in the models, says Meagan Burns, a senior informatics epidemiologist at MDPH. “These tools are very cool, but they’re also very new,” she says.

People in Massachusetts also are getting a look at disease forecasts as part of their weather news. Last February, meteorologists at Boston’s CBS affiliate, WBZ-TV, began adding localized disease data visualizations to their weather reports. These are put together by the Insight Net team based at Johns Hopkins and arranged through a collaboration with the American Meteorological Society. The first one featured a colorful chart showing that emergency room visits due to Covid-19 were declining steadily from their post-Christmas peak. The original plan was to do weekly check-ins on infectious respiratory illnesses, but as the weather warmed, infection numbers plummeted and stayed low.

“There were several weeks where there wasn’t a whole lot to talk about with Covid or the flu,” says meteorologist Terry Eliasen, executive producer of WBZ’s weather team. While viewers might find sunny weather forecasts useful, there didn’t seem to be much news value in “sunny” public health numbers. So WBZ skipped a few weeks. Then Eliasen asked the Johns Hopkins team what else it could do. Over the summer, researchers responded with data visualizations related to outbreaks of norovirus and eastern equine encephalitis, as well as the risk of heat-related illnesses.

This quick shift in focus drew praise as a sign that the university-based modelers at Insight Net are serious about partnering with public health practitioners and communicators. The CFA worked with the Council of State and Territorial Epidemiologists, or CTSE, on the legal and logistical issues of data-sharing, and to see what forecasting tools might be useful to its members. The two organizations convened a series of meetings with state and local health officials to ask what uses they might have for forecasting tools and whether there were specialized techniques they’d like. That was especially useful, says Janet Hamilton, the CSTE’s executive director. “We need to have enough time to talk to the modelers to say, ‘That’s a great model but it doesn’t help me. It doesn’t answer my questions.’”

Disease threats do not yet have the color-coded, real-time tracking maps the National Weather Service uses for potential hurricanes. Of course, there are no satellite images of developing disease threats, which not only are propelled by unique (and often mutating) biology, but also have to account for something that’s even harder to predict—human behavior. Several Insight Net forecasters are trying to meet this massive data challenge by mixing traditional data sources such as infection rates with the digital breadcrumbs of human activity like searches for symptoms, social media posts, and trends in medication purchases.

People spread diseases when they travel and gather, notes Alessandro “Alex” Vespignani, a physicist and computational scientist at Northeastern University whose lab models large-scale complex systems. He and his team are part of an Insight Net research consortium with Maine’s major hospital systems, MaineHealth and Northern Light Health, which are working on a pilot project to weave human mobility data into disease models. They draw on aggregated and anonymized mobile device location data, databases of global flight schedules, and traces of pathogens found in wastewater sampled from municipal sources and from international flights for analysis by the Boston biotech company Ginkgo Bioworks.


For all of Undark’s coverage of the global Covid-19 pandemic, please visit our extensive coronavirus archive.

“Our models are like a layer cake,” Vespignani says, with each layer creating a virtual “business as usual world” the modelers use for outbreak simulations. Layers are only added if they significantly improve the model’s predictions or extend the timeline for an accurate forecast. For instance, the lab found that it could accurately forecast greater Boston hospital admission rates three weeks ahead of time by adding mobility and proximity data derived from about 82,000 mobile phones, compared to just two weeks using conventional public health data such as statewide Covid test results. That extra week for planning is “a big deal for hospitals” for scheduling staff and procedures, says Samuel Scarpino, director of Northeastern University’s Institute for Experiential AI and a member of the Insight Net team. Since hospitals aim for 90 percent capacity, even a slight uptick in the need for beds can complicate care.

This fall, the lab will tap retrospective data from Maine’s Covid hospitalization numbers to try to replicate that forecasting capability. It’s also planning to use the mobility-enhanced models to forecast hospitalizations for flu, RSV, and Covid at individual Maine hospitals this winter. If these efforts are successful, Scarpino hopes to scale the models for use nationwide.

The Insight Net initiative also faces the labyrinthine way the U.S. gathers and shares core public health data such as test results and hospital records. Reducing those obstacles is a key target of the CDC’s Data Modernization Initiative, launched in 2019 to promote things like electronic case reporting, interoperability among different data collection systems, and standardized data use agreements between state, tribal, local and territorial, and federal health authorities. But the data pipeline’s bottlenecks aren’t simply technical and legal, according to infectious disease experts such as Jennifer Nuzzo, an epidemiologist who directs Brown University’s Pandemic Center. They also involve whether we’re asking the right questions about disease threats to get the data we need. “It’s great for us to invest in analytic approaches that can help us tell what could happen in the future,” says Nuzzo. “But what I want to see is a better utilization, analysis, and visualization of the data that we have to tell us what’s happening today.”

For instance, the fragmented efforts to track the H5N1 bird flu virus in the U.S. have drawn a chorus of concern from public health leaders and researchers. Last year, the virus leapt from wild birds to more than 100 million poultry in 49 states as well as other domesticated species, including dairy cows and, more recently, pigs. A small but growing number of people have also been infected (mostly farm workers, but not all). Tracking the virus requires coordination among multiple federal agencies, including the Department of Agriculture, the Food and Drug Administration, and the CDC, as well as states that vary widely in the ways they test animals, people, and bulk milk tanks.

Thus far, most humans with bird flu have had minor symptoms, and there’s no evidence of the virus spreading from person to person, which could trigger a pandemic. But the risk increases with flu season, because different viruses infecting the same host can swap genes (known as genetic reassortment) and evolve into something new and more dangerous. If pandemics were hurricanes, having the avian flu virus circulating in cows along with regular flu infections in humans would be akin to a low pressure system in the Caribbean — it could dissipate, but it could also develop into huge trouble for the mainland United States. Nuzzo says we could better predict the outcome if we focused more on targeted surveillance about emerging health threats.

Fragmented efforts to track the H5N1 bird flu virus in the U.S. have drawn a chorus of concern from public health leaders and researchers.

“An awareness of what’s happening this week, and last week, is the starting point for trying to figure out what’s going to happen in the next few weeks and beyond,” says Roni Rosenfeld, a professor of machine learning, language technologies, computer science, and computational biology in the School of Computer Science at Carnegie Mellon University and a cofounder of the Delphi Research Group, a global network of disease modelers working with Insight Net. “So, already before the pandemic, we shifted much of our effort to what I call situational awareness — being aware of what’s happening right now at as fine a geographic, pathogenic, syndromic, and demographic granularity as possible.”

Dylan George, director of the CFA, agrees that disease forecasts will require better raw data and more proactive surveillance. He argues now is the time to strengthen partnerships between researchers and public health practitioners, to build trust and a shared language, and to smooth frictions that can cripple effective collaboration during a crisis. The ultimate test of success for Insight Net, he says, will be seeing them in action:

“If a bunch of state and local health department folks are saying, ‘These forecasting tools are helping me do my job better,’ then I know that we deserve to live another day.”

Chris Berdik is a Boston-based science journalist.

In April 2017, three months after Donald Trump was inaugurated president, tens of thousands of scientists and their supporters gathered on Boston Common in the damp, chilly air to protest the new administration’s proposed steep budget cuts to medical research.

The March for Science, echoed in similar rallies across the country, pushed back on Trump’s statements denying climate change and his administration’s plan to slash billions of dollars from the National Institutes of Health, the federal government’s largest funder of medical research.

The simmering threat of bird flu may be inching closer to boiling over.

This year has been marked by a series of concerning developments in the virus’ spread. Since April, at least 65 people have tested positive for the virus — the first U.S. cases other than a single infection in 2022. Dairy cow herds in 16 states have been infected this year. The Centers for Disease Control and Prevention confirmed the country’s first severe bird flu infection on Wednesday, a critically ill patient in Louisiana. And California Gov. Gavin Newsom declared a state of emergency last week in response to rampant outbreaks in cows and poultry.

“The traffic light is changing from green to amber,” said Dr. Peter Chin-Hong, a professor of medicine at the University of California, San Francisco, who studies infectious diseases. “So many signs are going in the wrong direction.”

No bird flu transmission between humans has been documented, and the CDC maintains that the immediate risk to public health is low. But scientists are increasingly worried, based on four key signals.

For one, the bird flu virus — known as H5N1 — has spread uncontrolled in animals, including cows frequently in contact with people. Additionally, detections in wastewater show the virus is leaving a wide-ranging imprint, and not just in farm animals.

Then there are several cases in humans where no source of infection has been identified, as well as research about the pathogen’s evolution, which has shown that the virus is evolving to better fit human receptors and that it will take fewer mutations to spread among people.

Together, experts say, these indicators suggest the virus has taken steps toward becoming the next pandemic.

“We’re in a very precarious situation right now,” said Scott Hensley, a professor of microbiology at the University of Pennsylvania.

Widespread circulation creates new pathways to people
Since this avian flu outbreak began in 2022, the virus has become widespread in wild birds, commercial poultry and wild mammals like sea lions, foxes and black bears. More than 125 million poultry birds have died of infections or been culled in the U.S., according to the U.S. Agriculture Department.

An unwelcome surprise arrived in March, when dairy cows began to fall ill, eat less feed and produce discolored milk.

Research showed the virus was spreading rapidly and efficiently between cows, likely through raw milk, since infected cows shed large amounts of the virus through their mammary glands. Raccoons and farm cats appeared to get sick by drinking raw milk, too.

The more animals get infected, the higher the chances of exposure for the humans who interact with them.

“The more people infected, the more possibility mutations could occur,” said Jennifer Nuzzo, a professor of epidemiology and the director of the Brown University School of Public Health’s Pandemic Center. “I don’t like giving the virus a runway to a pandemic.”

Until this year, cows hadn’t been a focus of influenza prevention efforts.

“We didn’t think dairy cattle were a host for flu, at least a meaningful host,” Andrew Bowman, a professor of veterinary preventive medicine at Ohio State University, told NBC News this summer.

But now, the virus has been detected in at least 875 herds of cows across at least 16 states, as well as in raw (unpasteurized) milk sold in California and in domestic cats who drank raw milk.

“The ways in which a community and consumers are directly at risk now is in raw milk and cheese products,” Chin-Hong said. “A year ago, or even a few months ago, that risk was lower.”

Cases with no known source of exposure
The majority of the human H5N1 infections have been among poultry and dairy farmworkers. But in several puzzling cases, no source of infection has been identified.

The first was a hospitalized patient in Missouri who tested positive in August and recovered. Another was a California child whose infection was reported in November.

Additionally, Delaware health officials reported a case of H5N1 this week in a person without known exposure to poultry or cattle. But CDC testing could not confirm the virus was bird flu, so the agency considers it a “probable” case.

In Canada, a British Columbia teenager was hospitalized in early November after contracting H5N1 without any known exposure to farm or wild animals. The virus’ genetic material suggested it was similar to a strain circulating in waterfowl and poultry.

Such unexplained cases are giving some experts pause.

“That suggests this virus may be far more out there and more people might be exposed to it than we previously thought,” Nuzzo said.

Rising levels of bird flu in wastewater
To better understand the geography of bird flu’s spread, scientists are monitoring wastewater for fragments of the virus.

“We’ve seen detections in a lot more places, and we’ve seen a lot more frequent detections” in recent months, said Amy Lockwood, the public health partnerships lead at Verily, a company that provides wastewater testing services to the CDC and a program called WastewaterSCAN.

Earlier this month, about 19% of the sites in the CDC’s National Wastewater Surveillance System — across at least 10 states — reported positive detections.

It’s not possible to know if the virus fragments found came from animal or human sources. Some could have come from wild bird excrement that enters storm drains, for example.

“We don’t think any of this is an indication of human-to-human transmission now, but there is a lot of H5 virus out there,” said Peggy Honein, the director of the Division of Infectious Disease Readiness & Innovation at the CDC.

Lockwood and Honein said the wastewater detections have mostly been in places where dairy is processed or near poultry operations, but in recent months, mysterious hot spots have popped up in areas without such agricultural facilities.

“We are starting to see it in more and more places where we don’t know what the source might be automatically,” Lockwood said, adding: “We are in the throes of a very big numbers game.”

One mutation away?
Until recently, scientists who study viral evolution thought H5N1 would need a handful of mutations to spread readily between humans.

But research published in the journal Science this month found that the version of the virus circulating in cows could bind to human receptors after a single mutation. (The researchers were only studying proteins in the virus, not the full, infectious virus.)

“We don’t want to assume that because of this finding that a pandemic is likely to happen. We only want to make the point that the risk is increased as a result of this,” said paper co-author Jim Paulson, the chair of molecular medicine at Scripps Research.

Separately, scientists in recent months have identified concerning elements in another version of the virus, which was found in the Canadian teenager who got seriously ill. Virus samples showed evidence of mutations that could make it more amenable to spreading between people, Hensley said.

A CDC spokesperson said it’s unlikely the virus had those mutations when the teen was exposed.

“It is most likely that the mixture of changes in this virus occurred after prolonged infection of the patient,” the spokesperson said.

The agency’s investigations do not suggest that “the virus is adapting to readily transmit between humans,” the spokesperson added.

The viral strain in the United States’ first severe bird flu case, announced on Wednesday, was from the same lineage as the Canadian teen’s infection.

Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, said the CDC is assessing a sample from that patient to determine if it has any concerning mutations.

Hensley, meanwhile, said he’s concerned that flu season could offer the virus a shortcut to evolution. If someone gets co-infected with a seasonal flu virus and bird flu, the two can exchange chunks of genetic code.

“There’s no need for mutation — the genes just swap,” Hensley said, adding that he hopes farmworkers get flu shots to limit such opportunities.

Future testing and vaccines
Experts said plenty can be done to better track bird flu’s spread and prepare for a potential pandemic. Some of that work has already begun.

The USDA on Tuesday expanded bulk testing of milk to a total of 13 states, representing about 50% of the nation’s supply.

Nuzzo said that effort can’t ramp up soon enough.

“We have taken way too long to implement widespread bulk milk testing. That’s the way we’re finding most outbreaks on farms,” she said.

At the same time, Andrew Trister, chief medical and scientific officer at Verily, said the company is working to improve its wastewater analysis in the hope of identifying concerning mutations.

The USDA has also authorized field trials to vaccinate cows against H5N1. Hensley said his laboratory has tested a new mRNA vaccine in calves.


...

Keith Poulsen’s jaw dropped when farmers showed him images on their cellphones at the World Dairy Expo in Wisconsin in October. A livestock veterinarian at the University of Wisconsin, Poulsen had seen sick cows before, with their noses dripping and udders slack.

But the scale of the farmers’ efforts to treat the sick cows stunned him. They showed videos of systems they built to hydrate hundreds of cattle at once. In 14-hour shifts, dairy workers pumped gallons of electrolyte-rich fluids into ailing cows through metal tubes inserted into the esophagus.

“It was like watching a field hospital on an active battlefront treating hundreds of wounded soldiers,” he said.

Nearly a year into the first outbreak of the bird flu among cattle, the virus shows no sign of slowing. The U.S. government failed to eliminate the virus on dairy farms when it was confined to a handful of states, by quickly identifying infected cows and taking measures to keep their infections from spreading. Now at least 875 herds across 16 states have tested positive.

Experts say they have lost faith in the government’s ability to contain the outbreak.

“We are in a terrible situation and going into a worse situation,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “I don’t know if the bird flu will become a pandemic, but if it does, we are screwed.”

To understand how the bird flu got out of hand, KFF Health News interviewed nearly 70 government officials, farmers and farmworkers, and researchers with expertise in virology, pandemics, veterinary medicine, and more.

Together with emails obtained from local health departments through public records requests, this investigation revealed key problems, including deference to the farm industry, eroded public health budgets, neglect for the safety of agriculture workers, and the sluggish pace of federal interventions.

Case in point: The U.S. Department of Agriculture this month announced a federal order to test milk nationwide. Researchers welcomed the news but said it should have happened months ago — before the virus was so entrenched.

“It’s disheartening to see so many of the same failures that emerged during the covid-19 crisis reemerge,” said Tom Bollyky, director of the Global Health Program at the Council on Foreign Relations.

Far more bird flu damage is inevitable, but the extent of it will be left to the Trump administration and Mother Nature. Already, the USDA has funneled more than $1.7 billion into tamping down the bird flu on poultry farms since 2022, which includes reimbursing farmers who’ve had to cull their flocks, and more than $430 million into combating the bird flu on dairy farms. In coming years, the bird flu may cost billions of dollars more in expenses and losses. Dairy industry experts say the virus kills roughly 2% to 5% of infected dairy cows and reduces a herd’s milk production by about 20%.

Worse, the outbreak poses the threat of a pandemic. More than 60 people in the U.S. have been infected, mainly by cows or poultry, but cases could skyrocket if the virus evolves to spread efficiently from person to person. And the recent news of a person critically ill in Louisiana with the bird flu shows that the virus can be dangerous.

Just a few mutations could allow the bird flu to spread between people. Because viruses mutate within human and animal bodies, each infection is like a pull of a slot machine lever.

“Even if there’s only a 5% chance of a bird flu pandemic happening, we’re talking about a pandemic that probably looks like 2020 or worse,” said Tom Peacock, a bird flu researcher at the Pirbright Institute in the United Kingdom, referring to covid. “The U.S. knows the risk but hasn’t done anything to slow this down,” he added.

Beyond the bird flu, the federal government’s handling of the outbreak reveals cracks in the U.S. health security system that would allow other risky new pathogens to take root. “This virus may not be the one that takes off,” said Maria Van Kerkhove, director of the emerging diseases group at the World Health Organization. “But this is a real fire exercise right now, and it demonstrates what needs to be improved.”

A Slow Start

It may have been a grackle, a goose, or some other wild bird that infected a cow in northern Texas. In February, the state’s dairy farmers took note when cows stopped making milk. They worked alongside veterinarians to figure out why. In less than two months, veterinary researchers identified the highly pathogenic H5N1 bird flu virus as the culprit.

Long listed among pathogens with pandemic potential, the bird flu’s unprecedented spread among cows marked a worrying shift. It had evolved to thrive in animals that are more like people biologically than birds.

After the USDA announced the dairy outbreak on March 25, control shifted from farmers, veterinarians, and local officials to state and federal agencies. Collaboration disintegrated almost immediately.

Farmers worried the government might block their milk sales or even demand sick cows be killed, as poultry are, said Kay Russo, a livestock veterinarian in Fort Collins, Colorado.

Instead, Russo and other veterinarians said, they were dismayed by inaction. The USDA didn’t respond to their urgent requests to support studies on dairy farms — and for money and confidentiality policies to protect farmers from financial loss if they agreed to test animals.

The USDA announced that it would conduct studies itself. But researchers grew anxious as weeks passed without results. “Probably the biggest mistake from the USDA was not involving the boots-on-the-ground veterinarians,” Russo said.

Will Clement, a USDA senior adviser for communications, said in an email: “Since first learning of H5N1 in dairy cattle in late March 2024, USDA has worked swiftly and diligently to assess the prevalence of the virus in U.S. dairy herds.” The agency provided research funds to state and national animal health labs beginning in April, he added.

The USDA didn’t require lactating cows to be tested before interstate travel until April 29. By then, the outbreak had spread to eight other states. Farmers often move cattle across great distances, for calving in one place, raising in warm, dry climates, and milking in cooler ones. Analyses of the virus’s genes implied that it spread between cows rather than repeatedly jumping from birds into herds.

Milking equipment was a likely source of infection, and there were hints of other possibilities, such as through the air as cows coughed or in droplets on objects, like work boots. But not enough data had been collected to know how exactly it was happening. Many farmers declined to test their herds, despite an announcement of funds to compensate them for lost milk production in May.

“There is a fear within the dairy farmer community that if they become officially listed as an affected farm, they may lose their milk market,” said Jamie Jonker, chief science officer at the National Milk Producers Federation, an organization that represents dairy farmers. To his knowledge, he added, this hasn’t happened.

Speculation filled knowledge gaps. Zach Riley, head of the Colorado Livestock Association, said he suspected that wild birds may be spreading the virus to herds across the country, despite scientific data suggesting otherwise. Riley said farmers were considering whether to install “floppy inflatable men you see outside of car dealerships” to ward off the birds.

Advisories from agriculture departments to farmers were somewhat speculative, too. Officials recommended biosecurity measures such as disinfecting equipment and limiting visitors. As the virus kept spreading throughout the summer, USDA senior official Eric Deeble said at a press briefing, “The response is adequate.”

The USDA, the Centers for Disease Control and Prevention, and the Food and Drug Administration presented a united front at these briefings, calling it a “One Health” approach. In reality, agriculture agencies took the lead.

This was explicit in an email from a local health department in Colorado to the county’s commissioners. “The State is treating this primarily as an agriculture issue (rightly so) and the public health part is secondary,” wrote Jason Chessher, public health director in Weld County, Colorado. The state’s leading agriculture county, Weld’s livestock and poultry industry produces about $1.9 billion in sales each year.

Patchy Surveillance

In July, the bird flu spread from dairies in Colorado to poultry farms. To contain it, two poultry operations employed about 650 temporary workers — Spanish-speaking immigrants as young as 15 — to cull flocks. Inside hot barns, they caught infected birds, gassed them with carbon dioxide, and disposed of the carcasses. Many did the hazardous job without goggles, face masks, and gloves.

By the time Colorado’s health department asked if workers felt sick, five women and four men had been infected. They all had red, swollen eyes — conjunctivitis — and several had such symptoms as fevers, body aches, and nausea.

State health departments posted online notices offering farms protective gear, but dairy workers in several states told KFF Health News that they had none. They also hadn’t heard about the bird flu, never mind tests for it.

Studies in Colorado, Michigan, and Texas would later show that bird flu cases had gone under the radar. In one analysis, eight dairy workers who hadn’t been tested — 7% of those studied — had antibodies against the virus, a sign that they had been infected.

Missed cases made it impossible to determine how the virus jumped into people and whether it was growing more infectious or dangerous. “I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, an executive director at the international organization the Coalition for Epidemic Preparedness Innovations, who served as assistant secretary for preparedness and response in the Obama administration.

Citing “insufficient data,” the British government raised its assessment of the risk posed by the U.S. dairy outbreak in July from three to four on a six-tier scale.

Virologists around the world said they were flabbergasted by how poorly the United States was tracking the situation. “You are surrounded by highly pathogenic viruses in the wild and in farm animals,” said Marion Koopmans, head of virology at Erasmus Medical Center in the Netherlands. “If three months from now we are at the start of the pandemic, it is nobody’s surprise.”

Although the bird flu is not yet spreading swiftly between people, a shift in that direction could cause immense suffering. The CDC has repeatedly described the cases among farmworkers this year as mild — they weren’t hospitalized. But that doesn’t mean symptoms are a breeze, or that the virus can’t cause worse.

“It does not look pleasant,” wrote Sean Roberts, an emergency services specialist at the Tulare County, California, health department in an email to colleagues in May. He described photographs of an infected dairy worker in another state: “Apparently, the conjunctivitis that this is causing is not a mild one, but rather ruptured blood vessels and bleeding conjunctiva.”

Over the past 30 years, half of around 900 people diagnosed with bird flu around the world have died. Even if the case fatality rate is much lower for this strain of the bird flu, covid showed how devastating a 1% death rate can be when a virus spreads easily.

Like other cases around the world, the person now hospitalized with the bird flu in Louisiana appears to have gotten the virus directly from birds. After the case was announced, the CDC released a statement saying, “A sporadic case of severe H5N1 bird flu illness in a person is not unexpected.”

‘The Cows Are More Valuable Than Us’

Local health officials were trying hard to track infections, according to hundreds of emails from county health departments in five states. But their efforts were stymied. Even if farmers reported infected herds to the USDA and agriculture agencies told health departments where the infected cows were, health officials had to rely on farm owners for access.

“The agriculture community has dictated the rules of engagement from the start,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “That was a big mistake.”

Some farmers told health officials not to visit and declined to monitor their employees for signs of sickness. Sending workers to clinics for testing could leave them shorthanded when cattle needed care. “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too,” said an email from the Weld, Colorado, health department.

“We know of 386 persons exposed — but we know this is far from the total,” said an email from a public health specialist to officials at Tulare’s health department recounting a call with state health officials. “Employers do not want to run this through worker’s compensation. Workers are hesitant to get tested due to cost,” she wrote.

Jennifer Morse, medical director of the Mid-Michigan District Health Department, said local health officials have been hesitant to apply pressure after the backlash many faced at the peak of covid. Describing the 19 rural counties she serves as “very minimal-government-minded,” she said, “if you try to work against them, it will not go well.”

Rural health departments are also stretched thin. Organizations that specialize in outreach to farmworkers offered to assist health officials early in the outbreak, but months passed without contracts or funding. During the first years of covid, lagging government funds for outreach to farmworkers and other historically marginalized groups led to a disproportionate toll of the disease among people of color.

Kevin Griffis, director of communications at the CDC, said the agency worked with the National Center for Farmworker Health throughout the summer “to reach every farmworker impacted by H5N1.” But Bethany Boggess Alcauter, the center’s director of public health programs, said it didn’t receive a CDC grant for bird flu outreach until October, to the tune of $4 million. Before then, she said, the group had very limited funds for the task. “We are certainly not reaching ‘every farmworker,’” she added.

Farmworker advocates also pressed the CDC for money to offset workers’ financial concerns about testing, including paying for medical care, sick leave, and the risk of being fired. This amounted to an offer of $75 each. “Outreach is clearly not a huge priority,” Boggess said. “I hear over and over from workers, ‘The cows are more valuable than us.’”

The USDA has so far put more than $2.1 billion into reimbursing poultry and dairy farmers for losses due to the bird flu and other measures to control the spread on farms. Federal agencies have also put $292 million into developing and stockpiling bird flu vaccines for animals and people. In a controversial decision, the CDC has advised against offering the ones on hand to farmworkers.

“If you want to keep this from becoming a human pandemic, you focus on protecting farmworkers, since that’s the most likely way that this will enter the human population,” said Peg Seminario, an occupational health researcher in Bethesda, Maryland. “The fact that this isn’t happening drives me crazy.”

Nirav Shah, principal deputy director of the CDC, said the agency aims to keep workers safe. “Widespread awareness does take time,” he said. “And that’s the work we’re committed to doing.”

As President-elect Donald Trump comes into office in January, farmworkers may be even less protected. Trump’s pledge of mass deportations will have repercussions whether they happen or not, said Tania Pacheco-Werner, director of the Central Valley Health Policy Institute in California.

Many dairy and poultry workers are living in the U.S. without authorization or on temporary visas linked to their employers. Such precarity made people less willing to see doctors about covid symptoms or complain about unsafe working conditions in 2020. Pacheco-Werner said, “Mass deportation is an astronomical challenge for public health.”

Not ‘Immaculate Conception’

A switch flipped in September among experts who study pandemics as national security threats. A patient in Missouri had the bird flu, and no one knew why. “Evidence points to this being a one-off case,” Shah said at a briefing with journalists. About a month later, the agency revealed it was not.

Antibody tests found that a person who lived with the patient had been infected, too. The CDC didn’t know how the two had gotten the virus, and the possibility of human transmission couldn’t be ruled out.

Nonetheless, at an October briefing, Shah said the public risk remained low and the USDA’s Deeble said he was optimistic that the dairy outbreak could be eliminated.

Experts were perturbed by such confident statements in the face of uncertainty, especially as California’s outbreak spiked and a child was mysteriously infected by the same strain of virus found on dairy farms.

“This wasn’t just immaculate conception,” said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. “It came from somewhere and we don’t know where, but that hasn’t triggered any kind of reset in approach — just the same kind of complacency and low energy.”

Sam Scarpino, a disease surveillance specialist in the Boston area, wondered how many other mysterious infections had gone undetected. Surveillance outside of farms was even patchier than on them, and bird flu tests have been hard to get.

Although pandemic experts had identified the CDC’s singular hold on testing for new viruses as a key explanation for why America was hit so hard by covid in 2020, the system remained the same. Bird flu tests could be run only by the CDC and public health labs until this month, even though commercial and academic diagnostic laboratories had inquired about running tests since April. The CDC and FDA should have tried to help them along months ago, said Ali Khan, a former top CDC official who now leads the University of Nebraska Medical Center College of Public Health.

As winter sets in, the bird flu becomes harder to spot because patient symptoms may be mistaken for the seasonal flu. Flu season also raises a risk that the two flu viruses could swap genes if they infect a person simultaneously. That could form a hybrid bird flu that spreads swiftly through coughs and sneezes.

A sluggish response to emerging outbreaks may simply be a new, unfortunate norm for America, said Bollyky, at the Council on Foreign Relations. If so, the nation has gotten lucky that the bird flu still can’t spread easily between people. Controlling the virus will be much harder and costlier than it would have been when the outbreak was small. But it’s possible.

Agriculture officials could start testing every silo of bulk milk, in every state, monthly, said Poulsen, the livestock veterinarian. “Not one and done,” he added. If they detect the virus, they’d need to determine the affected farm in time to stop sick cows from spreading infections to the rest of the herd — or at least to other farms. Cows can spread the bird flu before they’re sick, he said, so speed is crucial.

Curtailing the virus on farms is the best way to prevent human infections, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, but human surveillance must be stepped up, too. Every clinic serving communities where farmworkers live should have easy access to bird flu tests — and be encouraged to use them. Funds for farmworker outreach must be boosted. And, she added, the CDC should change its position and offer farmworkers bird flu vaccines to protect them and ward off the chance of a hybrid bird flu that spreads quickly.

The rising number of cases not linked to farms signals a need for more testing in general. When patients are positive on a general flu test — a common diagnostic that indicates human, swine, or bird flu — clinics should probe more deeply, Nuzzo said.

The alternative is a wait-and-see approach in which the nation responds only after enormous damage to lives or businesses. This tack tends to rely on mass vaccination. But an effort analogous to Trump’s Operation Warp Speed is not assured, and neither is rollout like that for the first covid shots, given a rise in vaccine skepticism among Republican lawmakers.

Change may instead need to start from the bottom up — on dairy farms, still the most common source of human infections, said Poulsen. He noticed a shift in attitudes among farmers at the Dairy Expo: “They’re starting to say, ‘How do I save my dairy for the next generation?’ They recognize how severe this is, and that it’s not just going away.”

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Our phones buzz with the same question every time an unusual outbreak makes the news: “What’s happening?” As physicians and frequent responders to infectious threats around the world, people assume we have immediate answers. But in the chaotic early days of an outbreak, even seasoned experts are navigating through more questions than certainties. This was recently the case with reports of a “mystery illness” in the Democratic Republic of Congo (DRC).

Recently, the World Health Organization reported 406 cases and 31 deaths from an unknown disease in the Panzi health zone, a remote area more than 400 miles from the capital Kinshasa. While investigations initially explored multiple possibilities, the DRC’s health ministry is attributing the outbreak to severe malaria — a devastating disease, especially for children under 5, whose vulnerability is heightened by food insecurity and malnutrition in the region. The World Health Organization is running further testing.

This time, the culprit may be a known disease. But the initial uncertainty underscores a critical truth: In a world where pathogens are constantly emerging and evolving, we must have systems in place to rapidly detect, investigate, and respond — especially when it’s not a familiar foe.

It’s a global health cliché to say that what circulates in Congo today could be in Colorado tomorrow. But it’s also true. And in these situations, time to detection and response matters because it can translate to lives saved. As political shifts fuel calls to pull back our global presence, the United States must strengthen its partnerships and its commitments to outbreak surveillance, response, and research worldwide. Failure to do so amplifies health threats abroad and increases risks here at home. When a disease can traverse distant shores in a single airplane flight, maintaining and strengthening these investments and relationships is not only an act of global leadership, but also an essential investment in America’s own security.

The U.S. has long played a central role in building surveillance systems to detect emerging infectious threats. In 1951, just five years after its founding, the Centers for Disease Control and Prevention launched the Epidemic Intelligence Service (EIS), training “disease detectives” to identify and contain outbreaks both domestically and globally. U.S. funding and expertise have since driven key initiatives like the Global Polio Eradication Initiative (GPEI) and the Integrated Disease Surveillance and Response (IDSR) systems. More recently, in 2016, the U.S. supported the creation of the Africa CDC to bolster public health capacity and response across the continent.

The President’s Emergency Plan for AIDS Relief (PEPFAR), while designed to combat the HIV pandemic, has arguably been the most impactful initiative for building global detection capacity. Launched 21 years ago, PEPFAR remains the largest single-disease global health investment ever made by any country, saving more than 26 million lives. From the start, it has funded laboratories, procured diagnostic equipment, trained local lab technicians, and built robust health information systems for monitoring and reporting reliable health data worldwide.

These investments have been critical not only for HIV surveillance but also for detecting and responding to other health threats like tuberculosis, malaria, and emerging pathogens. During the Covid-19 pandemic, those investments helped increase diagnostic and surveillance capacity for SARS-CoV-2 globally. Despite its undeniable impact and long-standing bipartisan support, recent partisan gridlock threatens PEPFAR’s future. Without it, vital systems for disease detection could collapse, and millions of HIV patients may lose access to lifesaving medication — jeopardizing their health and risking a resurgence of the global HIV pandemic.

Programs to detect when outbreaks emerge are vital, but so is responding swiftly and effectively the moment a threat is detected. This is why the U.S. has also established an extensive overseas network of public health partnerships and field offices. The CDC operates in more than 60 countries, including in the Democratic Republic of the Congo, where the current “mystery illness” emerged. The CDC’s presence there since 2002 has provided essential access and trust, empowering American experts to work side-by-side on responding to outbreaks with local health authorities from the start.

These relationships are not forged overnight and require trust. Without deep, pre-existing ties built on years of cooperation, training, and shared surveillance, the U.S. would be just another outsider scrambling to negotiate entry and information at the outset of a crisis. Take the global effort to monitor and contain emerging influenza strains: U.S. support underpins a network of international labs that track new flu variants, giving health officials a head start on vaccine development and public health measures. Or consider the 2016 Zika outbreak, when close collaboration with Latin American partners, supported by U.S. funding and expertise, helped rapidly identify transmission hotspots and target mosquito control interventions.

The U.S. is heavily involved in developing and deploying medical countermeasures that stop outbreaks in their tracks. During a recent Marburg virus outbreak in Rwanda, U.S. funding enabled the rapid deployment of tests, vaccines, and treatments — protecting health care workers, saving lives, and likely preventing the outbreak from spreading beyond the region, including to the U.S.

This reflects a long-standing U.S. commitment to medical countermeasure research and development. During the 2014-2016 West African Ebola outbreak, there were no vaccines or treatments to protect health care workers or care for patients. As providers working in Ebola Treatment Units in West Africa — and one of us later as a patient after contracting the disease — we saw firsthand the devastating consequences of this absence. Since then, U.S.-funded research has led to the development of effective Ebola vaccines and treatments, tools that have been critical in subsequent outbreaks and could one day be essential in a domestic crisis.

Each year, numerous U.S. agencies — including the National Institutes of Health, Biomedical Advanced Research and Development Authority, Department of Defense, and Administration for Strategic Preparedness and Response, and others — invest hundreds of millions of dollars into research and development of medical countermeasures. Without this funding, the global ability to respond to emerging health threats would erode, making it harder to protect frontline health care workers, provide lifesaving care to patients, and contain outbreaks before they spread — potentially to U.S. shores.

This is not to say these agencies are perfect. The CDC’s domestic outbreak responses, particularly during the Covid-19 pandemic, exposed areas in need of improvement. The NIH, too, has faced criticism for bureaucratic inefficiencies and redundancies. But these institutions have built immense scientific and operational capacities over decades.

Reforms that streamline processes, improve responsiveness, and enhance transparency are essential. But punishing these agencies for perceived overreach during Covid-19 is not. Discarding the expertise and infrastructure they have cultivated would be dangerously shortsighted. Instead, we must refine — not reject — the global health apparatus that has protected Americans and millions of others worldwide.

Equally concerning are misguided proposals like the “eight-year pause on infectious disease research” floated by Robert F. Kennedy Jr., whom President-elect Trump intends to nominate for Health and Human Services secretary. Infectious threats are unlikely to get the message that they are supposed to take such a pause. And stepping back from investing in critical areas — such as tools to combat antimicrobial resistance and climate change-driven vector-borne diseases, or harnessing synthetic biology and artificial intelligence to help us combat infectious diseases threats — will make the U.S. fall behind the rest of the world in our readiness. Microbes remain impervious to electoral cycles; parasites and pathogens are not swayed by partisan slogans.

The United States is the largest funder and implementer of global health programs, and it must remain so — regardless of which people or party are in positions of political power. There is no wall tall enough to shield us from the panoply of global pathogens.

Craig Spencer is a public-health professor and emergency-medicine physician at Brown University. Nahid Bhadelia is an associate professor of infectious diseases and the founding director of Boston University’s Center on Emerging Infectious Diseases. She was previously the senior policy adviser for global Covid-19 response on the White House COVID-19 Response Team.

All known life is homochiral. DNA and RNA are made from “right-handed” nucleotides, and proteins are made from “left-handed” amino acids. Driven by curiosity and plausible applications, some researchers had begun work toward creating lifeforms composed entirely of mirror-image biological molecules. Such mirror organisms would constitute a radical departure from known life, and their creation warrants careful consideration. The capability to create mirror life is likely at least a decade away and would require large investments and major technical advances; we thus have an opportunity to consider and preempt risks before they are realized. Here, we draw on an in-depth analysis of current technical barriers, how they might be eroded by technological progress, and what we deem to be unprecedented and largely overlooked risks (1). We call for broader discussion among the global research community, policy-makers, research funders, industry, civil society, and the public to chart an appropriate path forward.

A new threat now looms. In a recent publication in Science, we joined an esteemed list of researchers in raising the alarm about risks of ongoing efforts to create ‘mirror life’. If created, mirror life could lead to the destruction of life, the environment and food systems across the globe, including exacerbating inequities that already exist in low- and middle-income countries.

Every year, more than one million people die from antimicrobial resistance. It is one of the most important global health threats, according to the World Health Organization. This sentiment was echoed at the recent Jeddah Conference, where representatives from more than 57 countries pledged to move towards decisive multilateral action on antimicrobial resistance.

Antimicrobial resistance is also fundamentally a matter of health equity. It disproportionately affects low- and middle-income countries: diseases caused by bacteria that are resistant to antibiotics spread more quickly, and are more lethal, in developing countries. At the same time, high-income countries disproportionately contribute to the overconsumption and overproduction of antimicrobial drugs that can cause and exacerbate antimicrobial resistance in the first place.

This pattern of global inequity extends beyond antimicrobial resistance, with the Global South (countries of the developing world) often suffering the consequences of problems predominantly created by the Global North.

A new threat now looms. In a recent publication in Science, we joined an esteemed list of researchers in raising the alarm about risks of ongoing efforts to create “mirror life”. If created, mirror life could lead to the destruction of life, the environment and food systems across the globe, including exacerbating inequities that already exist in low- and middle-income countries. We must ensure that scientists and policymakers from developing countries are included as part of the discussions and leadership about governing mirror life.

Mirror life refers to organisms created with “mirror molecules”. Mirror molecules have the same structure as natural molecules, except they are flipped, like how one’s left hand is a mirrored version of one’s right hand. Proteins are made up of amino acids that are normally found in a “left-handed” form, and DNA is made up of nucleic acids that are normally found in a “right-handed” form. Mirror forms of these molecules, such as right-handed amino acids and left-handed nucleic acids, are rarely used in nature, but can be artificially created in laboratory settings. By putting together mirror proteins, DNA, and other mirror molecules, scientists may be able to create entire mirror lifeforms.

Spread unchecked
We argue in our paper that mirror bacteria (the form of mirror life most likely to be created first) could evade human, plant, and animal immune systems, which have evolved to protect against microbes found in nature. Beyond getting past our immune systems, mirror bacteria also could evade natural predators like viruses that target bacteria (bacteriophages), which would enable mirror bacteria to spread relatively unchecked throughout nature, with potentially devastating effects on the environment and the world’s food systems. A pandemic caused by mirror bacteria would have catastrophic effects worldwide. For these reasons, in our paper, we argue that mirror life should not be created. We call, as well, for broader governance around mirror molecules.

Mirror life may create unprecedented, worldwide risks, and its effects would be felt by all countries. The severity and scope of its impact could be quite unlike anything that has been seen before. Luckily, few laboratories are actively interested in the development of mirror life — and none of them are in developing countries. However, it would be a grave injustice if the discussion of governance around mirror life included only stakeholders in high-income countries, as it is the low- and middle-income countries that could be the most affected if mirror life were ever to be created. Hard as it is to imagine, the proliferation of mirror life, and its devastating consequences on human and animal immune systems, might require isolating bunkers to house humans and their life support systems — an expensive enterprise.

Covid-19 has demonstrated that the effects of novel biological threats hit hardest in the Global South. These countries are less able to provide emergency healthcare to those affected, and if we were to succeed in developing new drugs to counter mirror life, they would probably be amassed and stockpiled by high-income nations. This is the same pattern we’ve seen in practically every pandemic. The 1918 Influenza — which killed up to 50 million people — began spreading in Europe, yet South Africa and India were two of the worst affected countries. A pandemic due to mirror life could be much more disastrous.

It is imperative that those driving the threat from mirror bacteria recognise their responsibilities and actively engage leaders from low- and middle-income countries in the discussions around governance. Ensuring representation of the Global South will enable transparency and accountability. Engaging appropriate global entities to provide oversight and accountability over research into mirror life would be essential to facilitate the protection of all countries.

Countries and organisations in the Global North should work with regulators in developing countries to create governance for any laboratory that develops an interest in working on mirror life in the future. This would also prevent laboratories from dodging regulations by moving their research to developing countries.

Fortunately, scientists who are engaged in the research that would serve as a precursor to the creation of mirror life are cognisant of the risks. The development of mirror life is something that can still be halted. While an entire mirror bacterium could pose a significant threat, the synthesis of specific mirror biomolecules on their own do not pose similar risks — and, in fact, could lead to new medicines.

Oversight
For instance, mirror proteins have been touted as an option for creating drugs to fight HIV, still an ongoing pandemic disproportionately affecting regions such as southern Africa. Innovation in this space needs to be diffused worldwide, so that low- and middle-income countries can benefit just as much as high-income nations. The peaceful and beneficial uses of such precursor research underscore the need to engage experts everywhere in discussions about oversight and to instill a hyper-awareness as to when to stop the research before it becomes dangerous.

With mirror life, the world has the invaluable opportunity to avoid repeating the mistakes of the past. Practices that have led to antimicrobial resistance are key examples where actions taken by high-income countries can have negative effects in low- and middle-income countries. Similarly, (industrial) practices that have led to climate change have been largely led by countries of the Global North, with disproportionate impacts on the Global South. Air pollution has largely been caused by industrial corporations and high-income nations burning fossil fuels, yet it disproportionately affects low-income communities and causes diseases like lung cancer to become more prevalent in vulnerable populations.

Global action wasn’t taken rapidly enough to prevent the devastating consequences of antimicrobial resistance, climate change, and air pollution. The risks posed by the potential to create mirror life are unparalleled and fall in a class of their own. However, when it comes to mirror life, we have the chance to act wisely — now — and prevent a damaging worldwide impact. Incorporating global perspectives into the governance of mirror life is the only way to ensure we are all safe. DM

Wilmot G. James is a Professor in the Department of Health Services, Policy and Practice and Senior Advisor to the Pandemic Center in the School of Public Health, Brown University, Providence, Rhode Island. Vaughn S. Cooper is Professor in the Department of Microbiology and Molecular Genetics and a founder of the Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Biden administration officials said Wednesday they have no current plans to authorize a stockpiled bird flu vaccine, despite an escalating outbreak among livestock in the U.S. and at least 58 human infections across seven states.

The move means any decisions about a bird flu vaccine will likely be left to health officials in the incoming Trump administration, who may be led by anti-vaccine activist Robert F. Kennedy Jr., whom Trump has picked to lead the Department of Health and Human Services.

The virus has been spreading in dairy cows since the spring and had infected at least 774 herds in 16 states as of Wednesday, according to the Centers for Disease Control and Prevention. Last Friday, the Agriculture Department stepped up its response to the outbreak, issuing a federal order mandating testing of the national milk supply.

The USDA said the testing, set to begin next week in six states, will give farmworkers better confidence in the safety of their animals and their ability to protect themselves from infection, as well as give officials a better sense of where herds are infected.

The virus’s spread in mammals that have close contact with humans is concerning for public health experts, because it gives the bird flu many opportunities to jump to people and potentially mutate to spread effectively from person to person.

Almost all bird flu cases in the U.S. have been in farmworkers who have had contact with infected animals — either dairy cows or poultry — aside from a patient in Missouri and a child in California. A teen in Canada who got very sick and was hospitalized also had no clear contact with infected animals.

The federal government has two bird flu vaccine candidates available in limited quantities in the nation’s stockpile, though they need to be authorized by the Food and Drug Administration before they can be used.

In May, health officials said the government would begin looking at vaccination if the virus mutated in ways that would make existing antivirals like Tamiflu less effective, or if it appeared it was causing serious illness in people.

Dr. Nirav Shah, the CDC’s principal deputy director, said Wednesday that the criteria for deploying a vaccine remains the same.

“When we think about respiratory vaccines, their sweet spot is really in preventing severe disease and death,” Shah said. “When we look at what is currently unfolding with H5, even in the human cases, thankfully what we’ve seen thus far is mild disease,” he said, using a shorthand for the strain of the influenza virus causing the bird flu outbreak.

“That is not a guarantee, and that could change, but that is one of the things that we are on the lookout for because the vaccine would be maximally effective against reducing severity of disease,” Shah said. While the administration isn’t considering a vaccine today, that could change if the outbreak changes, he said.

Still, some public health experts believe the time for vaccination is now, particularly for farmworkers.

“I do not think we should gamble with farmworkers’ lives by waiting for them to be hospitalized or die before using the tools we have to protect them,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

A balancing act
Whether to authorize or deploy a vaccine is a constant balancing act for public health agencies, Shah said, noting that even the safest vaccine can come with side effects.

In 1976, at the first signs of an H1N1 swine flu outbreak in the U.S., public health officials quickly initiated a nationwide vaccine campaign. The shot, however, caused a small increased risk of Guillain-Barre syndrome, a rare condition that causes the immune system to attack healthy nerve cells.

The outbreak never spread widely, but it set public trust in the flu shot back decades.

“It led to an analysis and introspection about whether the response to those 13 cases of swine flu had been an overreaction,” Shah said. “And, indeed, there was a high degree of vaccine skepticism that emerged.”

Still, the public health agencies are prepared to authorize a vaccine for bird flu if needed, Shah said, adding officials are consistently testing strains against the vaccine candidates.

A spokesperson at the Administration for Strategic Preparedness and Response, an agency within HHS that manages the nation's stockpile, said the agency has worked to “fill and finish” vaccine doses of a candidate vaccine that’s well-matched to the virus circulating in dairy cows.

There will be up to 10 million doses available by the end of the first quarter of next year, enough to vaccinate 5 million people, the spokesperson said.

A spokesperson for the FDA said the agency is “actively engaged with federal partners in the U.S., as well as industry,” including evaluating potential vaccine candidates, should the need arise for use in people.

When is the right time?
Dr. William Schaffner, an infectious diseases expert at Vanderbilt University Medical Center, said there isn’t a need to authorize a vaccine at this time, given the lack of evidence of human-to-human spread nor signs that the virus is causing severe disease in people. Existing tools, such as antivirals and personal protective equipment, are sufficient enough right now, he said.

There are a higher number of cases, but Schaffner attributed that to public health officials looking harder for the virus through testing and surveillance.

Schaffner said the incoming Trump administration’s anti-vaccine rhetoric doesn’t change his stance.

“I think we should be very careful about anticipating what the new administration will do,” he said. “The administration will be getting a lot of good, solid scientific evidence, not only from people at the CDC and the Food and Drug Administration, but they will hear from industry and lots of public health officials and experts across the country.”

The Trump transition team didn’t respond to a request for comment.

Dr. Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory, also said it’s not necessary to authorize a vaccine at this time.

“We need to keep advocating based on the science and data to make informed decisions, or do the best we can at the intersection of science, economics and political science,” Poulsen said.

Nuzzo, of the Brown University School of Public Health, said that while antivirals are important for anyone exposed to or infected with the virus, their effectiveness is limited by a very small window of time in which they must be given. She also said the country’s testing strategy is not timely enough to adequately protect farmworkers.

A vaccine, she said, could protect farmworkers from the possibility of severe illness.

Poulsen said one issue officials could run into, however, is finding farmworkers who are willing to get the vaccine, noting that some may be distrustful of the shot.

“I would start with seasonal flu and only go to the H5N1 strains if they find that people are propagating virus or getting severely sick,” Poulsen said. “That has not happened.”

It’s hard to turn on the news or look online without seeing something related to bird flu. Also known as H5N1, the virus is spreading in a few states across the country and sickening animals and farm workers.

Additionally, bird flu bacteria was recently found in raw milk; last week, the U.S. Department of Agriculture ordered that both raw and unpasteurized milk must be tested for bird flu.

Given the circumstances, it’s only natural to worry about the virus, so we asked experts to share their thoughts. Below are the societal and health-based concerns they have about bird flu right now:

They’re worried about farm workers who make up most bird flu cases.
Experts told HuffPost the average person doesn’t need to panic at this point in time.

“Today, the greatest fear I have is for people that we know are being exposed to this virus directly ― so that’s the farm workers,” said Dr. Jennifer Nuzzo, a professor of epidemiology and the director of the Pandemic Center at Brown University School of Public Health in Rhode Island.

Farm workers who are in close contact with poultry and cows are currently at risk and are largely becoming infected; 56 of the 58 reported bird flu cases in the U.S. this year can be traced back to cattle or poultry exposure, according to the Centers for Disease Control and Prevention.

“We already know that they’re getting infected, and we know that they’re getting sick, and fortunately, they haven’t gotten very sick,” Nuzzo said. “They haven’t gotten severely ill, they haven’t died, but we literally don’t know why that’s happening.”

They are paying attention to non-farm worker cases as well.
A Canadian teenager with no underlying health conditions was also infected with bird flu and ended up in the hospital.

“That just shows you how much of a gamble the whole thing is, because you literally can’t predict it. Are you going to be like the farm worker who gets a frankly hideous case of conjunctivitis and some respiratory symptoms, or are you going to be like the teenager in British Columbia? You don’t know,” Nuzzo said.

“I want to be clear. I’m not talking about the general public. I am talking about people that we know are being exposed to this virus,” she added. “This virus is not yet capable of spreading between people, and although we’re also seeing increasing cases occurring with an unknown exposure — meaning we don’t know where they got it from ― that also is concerning to me, but those events are still quite rare.”

They’re concerned that it could swap genes with the seasonal flu, making it able to spread more easily.
“The concern is that H5N1 is an avian influenza. Influenza viruses are notorious for changing. They can shift over time, they can reassort with each other and make much bigger shifts quite quickly,” said Meghan Davis, an associate professor in the department of environmental health and engineering at the Johns Hopkins Bloomberg School of Public Health in Maryland.

“The reason this is important is that if you would have a person who is infected with both H5N1 and a seasonal flu, you now could have one of those bigger reassortment events,” Davis continued. “So, some swapping of the genes ... you might be able to give the H5N1 virus genes that make it more virulent in people or that make it possible to transmit more easily from person to person, and that’s definitely something we want to prevent.”

They’re worried about infections in household pets.
“For me, as an animal health specialist, I’m very worried about the amount of disease we’re seeing in animals, which is extraordinary,” Davis said. “We’re talking about millions of birds lost. We’ve got many dairy cows affected — I think we’re now up to over 700 herds in the country that have been impacted by it. It’s also a virus that can be lethal in some species, not just the marine mammals we heard about in prior years, but also cats.”

This goes for cats on farms that drink raw milk in addition to domestic cats, where the contamination source is unclear, she said. Cats could have had contact with a dead bird that’s infected with the virus, raw milk, or other infected animals, with Davis noting that “we’ve been finding that the virus can infect mice, and so that’s a huge concern as well.”

“I’m really trying to get it out there about the cats, because I think that it’s just so possible for an infection to occur,” she said. “And I worry ... because if you have a pet infected in a home, that’s a very different kind of exposure than even drinking the raw milk or having occupational contact as a worker on a farm.”

These infections could happen in folks who avoid potential contamination sources like raw milk and farms because they’re immunosuppressed or pregnant, Davis explained.

“We just don’t know what we might see in terms of the kind of infection that could come out of that kind of exposure,” she said.

Davis also noted that the same concerns extend to other household pets like dogs, who could also come in contact with birds, mice or other infection sources.

They’re worried about the consumption of raw milk.
In recent months, raw milk has grown in popularity as people like Robert F. Kennedy Jr. and Gwyneth Paltrow promote drinking it. However, raw milk is known to carry harmful bacteria and does not have proven health benefits when compared to pasteurized milk. Moreover, raw milk is directly tied to bird flu.

“If you’re someone who is drinking raw milk ... here’s what I’m worried about: The virus is spreading to more and more dairy farms. We know that when cows are infected, the amount of virus that’s in their milk is very high. We also know from animal studies that consuming H5N1-infected milk can make these animals that consume it very sick, including hideous neurologic symptoms,” Nuzzo said. “So when I connect those dots, that tells me I don’t think I would drink raw milk.”

However, you don’t need to be concerned if you drink pasteurized milk.

“Commercial pasteurization, which brings milk to a certain temperature for a certain duration of time, sometimes under pressure, is effective at inactivating the virus,” Davis said.

She also noted the importance of the USDA ordering raw and unpasteurized to be tested for bird flu, explaining that testing will help officials determine infected farms.

They’re concerned that the conditions that cause pandemics are only getting worse.
“I think it is really important for people to understand that the conditions that give rise to pandemics are only getting more pronounced,” Nuzzo said. “There are going to be more pandemics in the future. We should try to prevent them ... sounding the alarms right now with H5N1 is an attempt to just do that.”

She also explained how climate and environmental change plays a major role in the spread of new pathogens.

“The new pathogens that have the ability to infect people and then spread between people, they have to be things that we don’t have immunity to, and the majority of those come from wildlife,” Nuzzo said. “So, anything that shakes up our interaction with wildlife is what potentially creates risk.”

This includes things like deforestation, reforestation and land use changes, she said, in addition to “wild animals having more contact with humans, either directly or through domesticated animals, like cows and pigs.”

“Ultimately, it’s about creating more opportunities for people to become exposed to wildlife pathogens [and] allowing those wildlife pathogens to become adapted for infecting and spreading between humans,” Nuzzo said.

They’re worried that society isn’t doing enough to prepare for future pandemics.
Plenty of people are talking about bird flu right now for good reason.

“We’re trying to get government to do more to get ahead of this virus so that it doesn’t become a problem for general members of the public. Nobody wants to go through another pandemic, nobody wants a farm worker to lose his or her life just for putting milk in our fridges,” Nuzzo said. “So, we are kind of sounding the alarm for the purposes of policy and practice changes that could make everyone safer.”

Nuzzo noted that, because of how horrible COVID-19 was, people have a hard time grasping the idea that more pandemics will happen, hoping that they never have to go through something like that again. And it doesn’t help that society is often quick to say disease emergencies are over — a problem that Nuzzo argued stops us from planning more effectively against pandemics.

“And I think that is getting in the way of our doing the kinds of things that would just make us more ready for these events. ... It may come, it may not. But if we’re generally ready for it, then we don’t have to sit there and work ourselves up about it,” she said.

Shutting down everything, as was the case with the COVID pandemic, is not how society should have to respond to a pandemic, with Nuzzo saying, “That is not what responding to a pandemic is supposed to be.”

Instead, she explained that, to curtail a potential bird flu pandemic — or any pandemic, for that matter — the government should focus on preventing the virus from infecting more farm workers and killing people, getting ahead of it so it can’t mutate and become more contagious, developing medications, and improving indoor air quality.

“So that when these things happen, they don’t just wash over us and upend our lives,” Nuzzo said.

Health officials in Marin County are investigating a possible H5N1 bird flu case in a child.

Officials have been investigating since last week and are working with the California Department of Public Health and the Centers for Disease Control and Prevention to determine how the child was exposed.

The information was provided in a Friday “health status update” newsletter, and buried at the end of a paragraph about the county and state’s monitoring of the virus, raw milk and a note about a new USDA program designed to test milk nationwide.

If confirmed, this would be the second case of an infected child in California.

“It’s deeply concerning that another child may have H5N1. We need to know much more about this case, including some hypotheses for how she or he may have contracted the virus,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I. “Given the proximity of this case to the last case of H5N1 diagnosed in a child without known exposure to animals, it may be prudent to conduct a broader investigation, including a serologic study, to see if there is evidence of other infections in the area.”

Last month, state health officials announced a child in Alameda County was positive for the disease. Investigators have not been able to determine the source of exposure. The child suffered from mild respiratory symptoms, and no one else in the child’s family or day care was infected.

Neither the state nor county public health officials have responded to queries from The Times, and no further information was provided in the newsletter.

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The U.S. Department of Agriculture will begin testing the nation’s milk supply for the bird flu virus known as H5N1, nearly a year after the virus began circulating through dairy cattle, the department announced on Friday.

Under the new strategy, officials will test samples of unpasteurized milk from large storage tanks at dairy processing facilities across the country.

Farmers and dairy processors will be required to provide samples of raw milk on request from the government. And farm owners with infected herds will be required to provide details that would help officials identify more cases and contacts.

The rules were first floated in October and were supposed to be implemented in November. The first round of testing is now scheduled to begin the week of Dec. 16, according to the announcement on Friday.

The new strategy is a departure from the voluntary guidance that the department had issued during the outbreak. Many dairy farms have not complied with voluntary testing of milk or of dairy workers, leaving federal officials in the dark about how widely the virus might have spread.

“I have been absolutely frustrated that we do not know the extent of the outbreak in cattle,” Seema Lakdawala, a virologist at Emory University, said.

Many experts in the United States and elsewhere, including with the World Health Organization, have sharply criticized the lack of testing of cattle and of people who may be infected with the virus. The virus does not yet spread easily among people, but every untreated infection is an opportunity for it to gain the ability to do so, experts have said.

The virus replicates easily in the udders of cows, and raw milk from infected animals contains very high levels of the virus. At least some farm workers are thought to have become infected from droplets of milk, perhaps through their eyes.

Robert F. Kennedy, Jr., President-elect Donald J. Trump’s pick to lead the health department, has been a proponent of raw milk. California, the nation’s biggest dairy producer, recently recalled some raw milk products and halted their production after the virus was detected in some samples.

“The positive H5N1 samples from raw milk sitting on the shelves in California highlights the potential risk for milk processors who interact with milk before it’s pasteurized, and also to members of the public who consume raw milk,” said Samuel Scarpino, director of A.I. and life sciences at Northeastern University.

No one has yet been known to become ill from drinking raw milk, although farm animals, including cats, are thought to have died after consuming contaminated milk. Pasteurized milk sold to consumers has already been shown to be free of the virus.

The new rules are an attempt to gain control over the outbreak, Agriculture Secretary Tom Vilsack said in a statement.

The strategy “will give farmers and farmworkers better confidence in the safety of their animals and ability to protect themselves, and it will put us on a path to quickly controlling and stopping the virus’s spread nationwide,” he said.

It is unclear whether the incoming Trump administration will continue the program.

“Come Jan. 21, things could change again,” said Dr. Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory.

The virus has now been detected in 720 herds in 15 states, although experts believe that figure is a significant underestimate, given the lack of mandatory testing. At least 58 people, most of them farm workers, have also been infected.

The agency’s last major mandate on testing came in April, when it issued a federal order requiring that lactating dairy cows be tested for flu before being moved across state lines.

Under the new strategy, the Agriculture Department will monitor bulk milk samples from farms nationwide, and work with state officials to identify infected herds.
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Avian flu is storming through California, with more than 250 new cases detected among dairy herds in the past 30 days, according to the US Department of Agriculture. Since the flu was first detected in cattle in March, the USDA has confirmed more than 700 cases in 15 states. New England cattle have been spared so far, but there’s little reason to think that will last indefinitely.

To its credit, Massachusetts is testing all of its 95 licensed dairy farms, with inspectors collecting milk samples from farms’ bulk tanks. So far, Massachusetts has had no positive samples. Since avian flu was detected in Massachusetts birds, state officials imposed testing and health certification requirements for imported poultry and conduct routine surveillance testing for Massachusetts flock owners that sell birds or participate in shows.

But birds, cows, and diseases cross state lines. “To eliminate the virus on a national scale, we have to be able to do national surveillance,” said Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory.

The USDA announced Oct. 30 that it planned to enhance testing and monitoring for avian flu. But since the election, there’s been silence on any concrete plans. Obviously, implementing federal policy in the lame-duck days of a presidential administration is tricky. But cattle — and more importantly, the farmworkers who work with them — are getting sick. The Biden administration should implement a national policy requiring the bulk testing of milk as a means of surveillance that will make it easier to detect and contain the virus. That should be paired with efforts to protect farms and their workers as much as possible from financial repercussions when the virus is detected and to ensure farms have the tools they need to prevent the spread, including access to testing and personal protective equipment.

The highly pathogenic avian influenza, H5N1, has been circulating among birds for years but is now spreading among cows. The virus sickens cows, but symptoms can be treated and cows usually recover. More concerning, the US Centers for Disease Control and Prevention has confirmed 58 human cases, mostly among farmworkers. Those cases have generally been mild, with symptoms like pink eye. There are a few cases without known animal exposure, including a teenager from British Columbia who became seriously ill.

Epidemiologists say the bigger threat is that the virus, if left unchecked, could mutate into a form that causes more severe illness or spreads more rapidly among people. “I can’t tell you it is the next big thing,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. “But I also can’t tell you it’s not.”

Part of containing the spread is identifying where the virus is, and so far that’s not happening as efficiently as it could. Colorado implemented mandatory bulk milk testing in July amid a spate of avian flu cases in dairy herds, and its last confirmed case was mid-August. But many states simply aren’t testing cows or people. After all, there’s an economic cost to the testing itself and to quarantining those infected.

The USDA only requires testing of lactating dairy cows when they move across state lines.

Poulsen said testing can most easily be done in bulk. For example, in a state without known cases, testing milk at a central processing facility can rule out the presence of the virus. He said any rules should protect the confidentiality of farm records, so regulators know where virus is present but farmers are not stigmatized. The testing also needs to be paired with evidence-based regulations for controlling the movement of cattle — like requiring negative tests before a previously infected herd can move off a farm.

Federal and state governments can also play a role working with farms to figure out what they need to prevent and deal with an outbreak. This could involve bulk buying googles and gloves or offering education, testing services, and medication to farmworkers. This can be particularly challenging with farmworkers who lack legal immigration status or health insurance or who don’t speak English. Shira Doron, hospital epidemiologist at Tufts Medical Center, suggested the government needs to create financial incentives for farms to do the right thing for public health — which could include policies like compensating farmers for the money they lose after a positive test.

The United Kingdom has been stockpiling H5N1 vaccines, and the United States has vaccines in development, although they are not yet commercially available. Federal officials should continue to prepare in case vaccination becomes necessary.

Avian flu may now pose only a limited threat, but increased testing, containment, and preparedness will ensure it doesn’t become a bigger one.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.

Can we predict the ebb and flow of infectious disease the way meteorologists predict the weather?

The federal government has bet big on the concept with a new nationwide network called Insight Net, which links academic disease modelers with public health practitioners. The network comprises 13 research consortia with participants in 24 states and is funded with up to $262 million from the Centers for Disease Control and Prevention (CDC). Insight Net members are piloting analytical techniques that combine novel data sources to guide surveillance and inform decision-making during outbreaks. The end goal is to create something akin to a National Weather Service for disease.

Such capacity would be a game-changer for state and local health authorities and for hospitals. At the height of the COVID-19 pandemic, “we were not good at forecasting the demand,” says Douglas Sawyer, chief academic officer of MaineHealth, that state’s biggest hospital system. “We didn’t steer the ship, so to speak, with high fidelity as we wish we could have. We couldn’t prepare and shift resources in thoughtful ways.”

Many hospitals struggled with the crush of patients who needed intensive, isolated care. Because hospitals could not accurately predict the size of impending infection waves, many delayed or canceled routine health care such as physicals or cancer screenings. Meanwhile, Covid care sites built or converted by federal and state authorities ended up being largely unneeded.

These forecasting issues had serious financial consequences for hospitals—and serious health consequences for the public. Insight Net’s progress toward closing that information gap has been steady and marked by small but important victories—as well as plenty of reminders that even the best forecasts are only as good as the data that feed them.

Forecasting more than the next crisis
By linking people working in public health directly with disease modelers, the CDC aims to fix the ad hoc approach it used for pandemic forecasting, which was panned from almost the start. In the summer of 2020, a critique in Foreign Affairs labeled the CDC’s approach “an arbitrary assortment of academics” reacting on the fly and asserted no one today would handle hurricane response in that fashion. In 2021, the CDC tapped Caitlin Rivers, one of the article’s coauthors and an epidemiologist at Johns Hopkins Bloomberg School of Public Health, as the first associate director of its new Center for Forecasting and Outbreak Analytics (CFA). In 2023 the CFA established Insight Net, and Rivers, who had returned to Johns Hopkins, became director of its node in the network (Dylan George, her Foreign Affairs coauthor, is the CFA’s current director). Their core message, then and now: Disease forecasting shouldn’t be improvised.

Policymakers and the public put their trust in major storm alerts, according to George, because the weather service is “applying the best models in an operational context on a day in and day out basis, cranking out results,” George says. “And then you have local meteorologists interpret those results for people to actually make decisions.” That process establishes a track record of monitoring and communicating forecasts, including their uncertainty, even when the weather is calm, sunny, and mild. “We’ve tried to pattern after that,” George adds.

That has meant investing in a dedicated program for disease forecasting, with formal working relationships between modelers and federal, state, and local health officials. It also means the CFA has been keen to demonstrate how modeling can help public health practice and communication. For instance, it has tapped data from the National Wastewater Surveillance System, launched by the CDC in 2020, to improve localized forecasts of Covid hospital admissions. It also helped the Chicago Department of Public Health confront a March 2024 measles outbreak at a temporary migrant shelter housing more than 1,400 people. As public health workers began vaccinating and screening shelter residents to identify and isolate the sick, department leaders reached out to the CFA, which rapidly refined a model of measles to mimic the outbreak’s timeline of infection, symptom onset, and recovery, which Chicago health officials could then use to predict its future course.

The model didn’t influence the department’s interventions, which were already underway. But it did reassure officials they’d correctly identified their patient zero: Outbreak simulations that assumed earlier, undetected infections generated far different case data from what was observed. The forecasts also helped set expectations for the outbreak’s severity by providing a range of potential case numbers and dates when infections would peak and subside. After a couple weeks of continuous updating with data on new measles cases, the model predicted there would be between 57 and 65 cases and the final rash would appear on April 16. In the end, the outbreak lasted about two months and infected 57 people.

“It really helped our own planning, and our thinking about staffing,” says Stephanie Gretsch, an epidemiologist at the Chicago Department of Public Health. “It was also incredibly helpful for communicating with our city agency partners responsible for housing and schooling; and the hospitals we asked to help isolate infected residents, to give them a sense of how long we thought this was going to last.”

After the outbreak, Chicago public health officials used the modeling to quantify the value of its interventions. Outbreak simulations where responses did not include mass vaccination or active case-finding efforts suggested it would have lasted seven weeks longer and more than quadrupled the number of infections. This finding suggests that modeling hypothetical scenarios might offer a tool for easing heightened skepticism of public health interventions and investments, say several Insight Net partners.

Syphilis is one target of the Insight Net consortium at the University of Utah. The disease, resurgent in the U.S., can infect a fetus during pregnancy and cause serious medical complications, including miscarriage, stillbirth, and infant death. The goal is to “address the issues and show how bad this problem could get if trends continue,” says principal investigator Matthew Samore, a professor of medicine and the division chief of epidemiology at the University of Utah. “We also want to get a deeper understanding of how STIs like this are spreading through different populations…and to calculate how much benefit do we get by investing in more intensive screening and contact tracing.” By helping establish the extent of the risk, the models could bolster requests to fund more screening and treatment of groups with high infection rates, such as people in prison.

The modeling could also improve disease forecasting dashboards used by the public to assess health threats. The Massachusetts Department of Public Health (MDPH) has dashboards that track severe respiratory illnesses statewide, but delays in data reporting from local hospitals limit their usefulness. In 2024, MDPH worked with the Insight Net researchers at the University of Massachusetts Amherst and the University of Texas at Austin to build models filling in those gaps, allowing it to add recent emergency room visits and hospital admissions due to Covid, RSV, and influenza broken down by demographics. Such small-scale adoptions are needed both to validate disease forecasting and to build trust in the models, says Meagan Burns, a senior informatics epidemiologist at MDPH. “These tools are very cool, but they’re also very new,” she says.

People in Massachusetts also are getting a look at disease forecasts as part of their weather news. In February, meteorologists at Boston’s CBS affiliate, WBZ-TV, began adding localized disease data visualizations to their weather reports. These are put together by the Insight Net team based at Johns Hopkins and arranged through a collaboration with the American Meteorological Society. The first one featured a colorful chart showing that emergency room visits due to COVID-19 were declining steadily from their post-Christmas peak. The original plan was to do weekly check-ins on infectious respiratory illnesses, but as the weather warmed, infection numbers plummeted and stayed low.

“There were several weeks where there wasn’t a whole lot to talk about with Covid or the flu,” says meteorologist Terry Eliasen, executive producer of WBZ’s weather team. While viewers might find sunny weather forecasts useful, there didn’t seem to be much news value in “sunny” public health numbers. So WBZ skipped a few weeks. Then Eliasen asked the Johns Hopkins team what else it could do. Over the summer, researchers responded with data visualizations related to outbreaks of norovirus and eastern equine encephalitis, as well as the risk of heat-related illnesses.

This quick shift in focus drew praise as a sign that the university-based modelers at Insight Net are serious about partnering with public health practitioners and communicators. The CFA worked with the Council of State and Territorial Epidemiologists (CTSE) on the legal and logistical issues of data-sharing, and to see what forecasting tools might be useful to its members. The two organizations convened a series of meetings with state and local health officials to ask what uses they might have for forecasting tools and whether there were specialized techniques they’d like. That was especially useful, says Janet Hamilton, the CSTE’s executive director. “We need to have enough time to talk to the modelers to say, ‘That’s a great model but it doesn’t help me. It doesn’t answer my questions.’”

Fixing public health data: everything, everywhere, all at once
Disease threats do not yet have the color-coded, real-time tracking maps the National Weather Service uses for potential hurricanes. Of course, there are no satellite images of developing disease threats, which not only are propelled by unique (and often mutating) biology, but also have to account for something that’s even harder to predict—human behavior. Several Insight Net forecasters are trying to meet this massive data challenge by mixing traditional data sources such as infection rates with the digital breadcrumbs of human activity like searches for symptoms, social media posts, and trends in medication purchases.

People spread diseases when they travel and gather, notes Alessandro “Alex” Vespignani, a physicist and computational scientist at Northeastern University whose lab models large-scale complex systems. He and his team are part of an Insight Net research consortium with Maine’s major hospital systems, MaineHealth and Northern Light Health, which are working on a pilot project to weave human mobility data into disease models. They draw on aggregated and anonymized mobile device location data, databases of global flight schedules, and traces of pathogens found in wastewater sampled from municipal sources and from international flights for analysis by the Boston biotech company Ginkgo Bioworks.

“Our models are like a layer cake,” Vespignani says, with each layer creating a virtual “business as usual world” the modelers use for outbreak simulations. Layers are only added if they significantly improve the model’s predictions or extend the timeline for an accurate forecast. For instance, the lab found that it could accurately forecast greater Boston hospital admission rates three weeks ahead of time by adding mobility and proximity data derived from about 82,000 mobile phones, compared to just two weeks using conventional public health data such as statewide Covid test results. That extra week for planning is “a big deal for hospitals” for scheduling staff and procedures, says Samuel Scarpino, director of Northeastern University’s Institute for Experiential AI and a member of the Insight Net team. Since hospitals aim for 90 percent capacity, even a slight uptick in the need for beds can complicate care.

This fall, the lab will tap retrospective data from Maine’s Covid hospitalization numbers to try to replicate that forecasting capability. It’s also planning to use the mobility-enhanced models to forecast hospitalizations for flu, RSV, and Covid at individual Maine hospitals for the winter of 2024-25. If these efforts are successful, Scarpino hopes to scale the models for use nationwide.

The Insight Net initiative also faces the labyrinthine way the U.S. gathers and shares core public health data such as test results and hospital records. Reducing those obstacles is a key target of the CDC’s Data Modernization Initiative, launched in 2019 to promote things like electronic case reporting, interoperability among different data collection systems, and standardized data use agreements between state, tribal, local and territorial, and federal health authorities. But the data pipeline’s bottlenecks aren’t simply technical and legal, according to infectious disease experts such as Jennifer Nuzzo, an epidemiologist who directs Brown University’s Pandemic Center. They also involve whether we’re asking the right questions about disease threats to get the data we need. “It’s great for us to invest in analytic approaches that can help us tell what could happen in the future,” says Nuzzo. “But what I want to see is a better utilization, analysis, and visualization of the data that we have to tell us what’s happening today.”

For instance, the fragmented efforts to track the H5N1 bird flu virus in the U.S. have drawn a chorus of concern from public health leaders and researchers. Earlier this year, the virus leapt from wild birds to more than 100 million poultry in 49 states as well as other domesticated species, including dairy cows and, more recently, pigs. A small but growing number of people have also been infected (mostly farm workers, but not all). Tracking the virus requires coordination among multiple federal agencies, including the Department of Agriculture, the Food and Drug Administration, and the CDC, as well as states that vary widely in the ways they test animals, people, and bulk milk tanks. The only federally mandated H5N1 screening is for lactating dairy cows being moved across state lines.

Thus far, most humans with bird flu have had minor symptoms, and there’s no evidence of the virus spreading from person to person, which could trigger a pandemic. But the risk increases with flu season, because different viruses infecting the same host can swap genes (known as genetic reassortment) and evolve into something new and more dangerous. If pandemics were hurricanes, having the avian flu virus circulating in cows along with regular flu infections in humans would be akin to a low pressure system in the Caribbean—it could dissipate, but it could also develop into huge trouble for the mainland United States. Nuzzo says we could better predict the outcome if we focused more on targeted surveillance about emerging health threats.

“An awareness of what’s happening this week, and last week, is the starting point for trying to figure out what’s going to happen in the next few weeks and beyond,” says Roni Rosenfeld, a professor of machine learning, language technologies, computer science, and computational biology in the School of Computer Science at Carnegie Mellon University and a cofounder of the Delphi Research Group, a global network of disease modelers working with Insight Net. “So, already before the pandemic, we shifted much of our effort to what I call situational awareness—being aware of what’s happening right now at as fine a geographic, pathogenic, syndromic, and demographic granularity as possible.”

Dylan George, director of the CFA, agrees that disease forecasts will require better raw data and more proactive surveillance. He argues now is the time to strengthen partnerships between researchers and public health practitioners, to build trust and a shared language, and to smooth frictions that can cripple effective collaboration during a crisis. The ultimate test of success for Insight Net, he says, will be seeing them in action:

“If a bunch of state and local health department folks are saying, ‘These forecasting tools are helping me do my job better,’ then I know that we deserve to live another day.”

Illustration: Mary Delaware / Source images: Adobe Stock

By now, you’ve probably seen some alarming headlines about bird flu, and you may be wondering how worried you should be. I understand the uncertainty.

On the one hand, we have all spent decades hearing alarming stories about strange viruses — like MERS, Ebola, dengue and Zika — most of which don’t end up having a big effect on the U.S. On the other hand, one of those recent viruses turned into the life-altering Covid pandemic.

In today’s newsletter, I want to help you make sense of bird flu, using four questions.

Making sense of H5N1
1. What is bird flu?

It’s an influenza virus officially known as H5N1 (and sometimes called avian flu). It has been circulating for decades, and it attracted global attention in the late 1990s after an outbreak among chickens in southern China.

That outbreak was especially worrisome because it included the first documented human cases of the virus. At least 18 people were infected, six of whom died.

2. Why the recent concerns?

The virus has recently expanded in two ways: across regions and across species. Rather than being concentrated in Asia, bird flu has moved across much of the planet. And it has infected a wider variety of animals, including mammals. (This Times story explains.) Dairy cows in many parts of the United States have tested positive.

The number of human infections is also growing, as this chart by my colleague Ashley Wu shows:

Most concerning, at least four people have tested positive without evidently having had contact with a sick animal. One is them is a teenager in British Columbia who has been in critical condition. These infections raise the possibility that the virus can move from one human being to another, rather than only from an animal to a person. Human-to-human transmission can lead to much more rapid spread of a disease.

“I’m more worried about bird flu than I have been for a really long time,” Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, told me.

3. What are the reasons to be hopeful?

There are a few. First, it’s not yet clear whether those four recent cases stemmed from human-to-human transmission. Even if they did, such transmission might remain rare, involving extremely high levels of exposure to the virus. “Right now, H5N1 does not spread easily between people,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.

Second, H5N1 seems to have become less severe in human beings recently. The reasons aren’t clear, Nuzzo says, but one possibility is that a different flu that emerged in 2009 — H1N1 — may confer some immunity for H5N1. Millions of people have since had H1N1.

As my colleague Apoorva Mandavilli says, “Very few people known to be infected with bird flu in the United States have become seriously ill, and none have died.” Still, she notes that viruses evolve, often in ways that lead to more infections. And the upcoming winter could give bird flu more opportunities to mix with seasonal flu and mutate. If bird flu were to spread widely, even a low fatality rate could mean tens of thousands of deaths in the U.S.

4. How can the U.S. reduce the risks?

More testing — of birds, cows and farmworkers — would help. “We know very, very little about how far this virus has spread and how many people and animals have been infected,” Apoorva said. Testing could allow farms to isolate infected animals and people.

What about a vaccine? A vaccine for bird flu exists, but the supply is modest. Nuzzo believes the government should help expand production and make the vaccine available to farmworkers who want to receive it. More research on the vaccines also seems important, especially if the virus is evolving.

The bottom line
Rivers, the Johns Hopkins epidemiologist, recently published a book on preventing outbreaks called “Crisis Averted.” In it, she argues that one of the most effective public health strategies is honesty: Experts should level with people, rather than telling selective truths intended to shape behavior in paternalistic ways (as happened during Covid).

When I spoke with Rivers this week, I asked for some truth telling about bird flu. “As an epidemiologist, I’m worried,” she said. “I’m not worried as a mom or a member of my community. It’s not a threat that is imminent.”

But H5N1 bears watching. It is changing and spreading in uncertain ways, and it already presents a threat to many animals and to people who work closely with them.

For more: In Times Opinion, Zeynep Tufekci argues that President Biden should be more aggressive about fighting bird flu before leaving office.

President-elect Trump selected a critic of COVID-19 lockdowns and mandates to lead the National Institutes of Health. Dr. Jay Bhattacharya is known for co-authoring the Great Barrington Declaration, a 2020 manifesto that advocated allowing COVID to spread in order to achieve herd immunity. It was widely criticized by top health officials. William Brangham discussed more with Dr. Jennifer Nuzzo.

This month, two independent cases of bird flu were detected in North American children without any known exposure to infected animals, raising concerns that the H5N1 virus that causes it is inching closer to evolving in a way that allows it to spread between humans.

Since April, 55 H5N1 cases have been reported in humans, and all but three have occurred in farmworkers in close contact with dairy cows or poultry, which the virus is infecting in droves. But health officials have not been able to determine the source of three cases in humans, raising questions about whether there is low-level community spread happening.

On Nov. 9, government officials in British Columbia reported that a teenager tested positive for H5N1 with no known exposure to an infected animal. Last week, a child in the Bay Area also tested positive for bird flu without any known exposures. These two cases follow a third infection in Missouri reported in September, for which health officials were unable to determine the origins of the infection after an extensive investigation.

“The big takeaway is that there is more community spread than is being detected,” said Dr. Abraar Karan, an infectious disease physician at Stanford University. “When you can’t figure out where the infection came from, that raises a lot of red flags.”

Without exposure to farm animals, it’s possible these children could have become infected after coming into contact with a wild bird infected with the virus. Another possibility is that they could have come into contact with a domesticated animal that had the virus. However, in the Canadian teen's case, all of the pets they came into contact with tested negative, said Bonnie Henry, a public health officer for the province of British Columbia in Victoria, Canada, during a press conference.

“There is a very real possibility that we may not ever determine the source,” Henry said.

In another press conference hosted today, Henry said the case in the teen was a “rare” event and that all of the healthcare workers or close contacts of the teenager have tested negative after a 10-day incubation period.

“Even if there was a mutation in the young person in the virus here, right now, that would have died off because we have not seen any other transmission,” Henry said. “That is reassuring, but it just reminds us that the influenza virus can change quite rapidly, so we need to be on our guard.”

While the H5N1 virus has not shown the ability to spread between humans, each time it infects someone or mammals like cows and pigs, it raises the chances that it could evolve to adapt in a way that makes it more transmissible between humans, possibly triggering a pandemic like COVID-19. This is of particular concern amid the standard influenza season because genes could swap and mutate in an organism infected with both the seasonal flu and bird flu in a process called viral reassortment.

“It is always difficult to know exactly what set of mutations are actually required to make [human-to-human transmission] happen,” Karan told Salon in a phone interview. “There are mutations that make the virus more effective at finding and entering cells; mutations that allow certain enzymes within the virus to more effectively replicate the virus and help it spread more; mutations that can help the virus be more stable in aerosols … Generally, you need multiple mutations to occur for you to have something that efficiently transmits between humans.”

Again, if the H5N1 virus develops the ability to efficiently spread between humans, the world will be faced with another pandemic, said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.

“The overall trend is that this virus is really increasing its geographic distribution, the virus is really increasing the number of animal species it's infecting, and this virus seems to be increasing in the numbers and types of humans it is infecting,” Nuzzo told Salon in a phone interview.

The rate at which H5N1 is spreading in cows is unprecedented. As of this writing, roughly 600 dairy herds had been infected in 15 states, and more than 100 million poultry were impacted in 49 states, according to the Centers for Disease Control and Prevention (CDC). This week in California, bird flu was also detected in raw milk that was being sold in stores, another first. Though the risk level of contracting bird flu from drinking milk is unknown, it has been shown to transmit the virus to cats and other animals. The virus was also detected in pigs for the first time, which is particularly concerning because pigs are known as “mixing vessels,” as they can contract both human and avian pathogens, increasing the chances of viral reassortment.

In the 2009 swine flu pandemic, multiple reassortment events in pigs and birds led to the novel H1N1 virus strain, which led to 60 million cases and 12,000 deaths in the U.S. in its first year of circulating, per the CDC.

Although the majority of cases in humans have been mild, bird flu historically has a far higher case-fatality rate than the current outbreak. This is partly because most cases circulating before this outbreak were caused by a type of the virus that primarily affects birds, while most of the cases in the U.S. in the current outbreak have been caused by the type that primarily affects cows.

However, the Canadian teen was hospitalized in critical condition with a severe reaction to the virus. Viral genome sequences indicate the teen was infected with the type of bird flu typically found in birds, and that this type of the virus might have mutated in a way that increased its ability to attach to the human respiratory tract. However, the teen developed an eye infection first, followed by a lung infection, which could suggest that the virus adapted after it infected the young person.

“It’s consistent with the idea that the virus might have evolved within that individual,” says Hensley.

Cases like the one in Canada will likely be caught in surveillance systems due to their severity. While milder disease is obviously better for human health, it also makes it more challenging to detect community spread, said Dr. Erin Sorrell, a virologist at the Johns Hopkins Center for Health Security. In one CDC study, 7% of farmworkers had antibodies that suggested they had previously been infected with bird flu, which is far higher than the proportion of cases actually reported.

“Because it is presenting in a mild fashion and initially came out in a very vulnerable population that did not have access to care, the virus has been able to essentially sustain itself undetected,” Sorrel told Salon in a phone interview.

Meanwhile, the world is watching anxiously as the U.S. reacts to bird flu, and some have criticized the nation for not stamping out the virus in birds or cattle before it infects more humans. As of this writing, bird flu has been detected in more than 10,000 wild birds, which is concerning as many of these species continue to migrate to other parts of the world. Last week, bird flu was reported in Hawaii and continued to spread in other countries in Europe like the Netherlands.

“I am really concerned that the investigation by the USDA and the methods put in place to limit transmission are clearly not successful at this point,” said Dr. Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “This is a real challenge.”

Time will tell if the cases in Canada and California were “one-offs” like the case in Missouri. But with each additional human case that is not tied to farm animals, that seems to be becoming less likely.

“This virus continues to spread, popcorning up around the country and over the border in Canada, and I think this means this is going to be a protracted threat to U.S. agriculture and public health,” Nuzzo said. “The virus is not going away, we are not taking steps to make it go away, and therefore it is going to keep on going.”

The announcements came Friday night, one after another, President-elect Donald Trump’s picks for the country’s premier health leadership roles: a New York family physician and Fox News medical contributor for surgeon general; a Florida physician and former congressman to lead the US Centers for Disease Control and Prevention; a surgeon and researcher at Johns Hopkins for the US Food and Drug Administration.

Public health experts, former government officials and researchers — including 10 who spoke with CNN — began meting out praise, critiques and questions about Trump’s picks: Dr. Janette Nesheiwat for US surgeon general, Dr. David Weldon for CDC director and Dr. Marty Makary for FDA commissioner, each of whom will face a Senate confirmation hearing.

Several health experts said Makary and Nesheiwat were reasonable choices who may be tested under a federal health department with Robert F. Kennedy Jr., a prominent anti-vaccine conspiracy theorist, at the helm of the US Department of Health and Human Services. Several also raised concerns about Weldon, Trump’s pick to lead the CDC, who had previously introduced legislation that would have shifted vaccine safety oversight away from the CDC and has repeatedly raised questions about the safety of vaccines that had already been studied.

A key challenge for all of the Trump administration’s new public health leaders, the experts said, will be keeping politics out of science.

CNN has reached out to Nesheiwat and Makary for comment and did not receive a response. CNN was not able to reach Weldon.

In a response to questions from CNN, Katie Miller, a spokesperson for the Trump transition, said “Mr. Kennedy is the right choice to lead HHS and put Americans back in charge of their healthcare, not corporations.”

‘It’s very hard to defy your boss’
Dr. Ashish Jha, dean of Brown University’s School of Public Health and former White House Covid-19 response coordinator under President Joe Biden, said that one important question for senators to push each of the candidates on will be how they would handle a situation in which recommendations from scientists at the CDC or the FDA conflict with what the health secretary wants.

“It’s reasonable to disagree with people” on health policy, Jha said. “There are people out there who are smart, who are well-trained, who believe in modern medicine, who come out differently than I do because they read data differently than I do. That is a very normal part of scientific discourse.”

Several experts who spoke with CNN generally described Makary and Nesheiwat as open-minded physicians who respect the scientific process – even if they disagree with some of their policies. Some said that could put them at odds with Kennedy, whom Trump has chosen for the nation’s top health post as HHS secretary.

“It’s very hard to defy your boss,” Jha said. “There’s going to be an immense pressure on the CDC director, on the FDA commissioner, on all of these people. It’ll be very difficult for them to just make the decisions that are right for the health of the American people and not get swayed by someone who doesn’t understand evidence and data but has strongly held views.”

Weldon has his own partisan past with vaccines, and his nomination for CDC director has garnered far more hesitancy among experts.

“While Drs Makary and Nesheiwat seemingly lack experience in managing large organizations like the FDA and [the US Public Health Service], I believe they are competent physicians who will prioritize science-based decision making,” Dr. Jerome Adams, who served as surgeon general in the first Trump administration, said in an email to CNN.

“However, beyond his own lack of experience with large organizations (and the CDC is a behemoth), I have concerns about Dr. Weldon’s past statements on vaccines and believe he should be closely scrutinized on this issue during confirmation,” Adams wrote. “The CDC plays a critical role in global health, and it would be disastrous if its leader were to promote unfounded theories and exacerbate vaccine hesitancy.”

Vaccine views as a health policy bellwether
Vaccination is far from the only issue on which federal health leaders guide policy, but experts say that it is one of the most important right now — and it could be a bellwether of each leader’s approach.

The Covid-19 pandemic brought vaccines to the forefront of public health awareness and created opportunities for increased scrutiny but also dangerous skepticism and conspiracies that have had deadly consequences, said Dr. Peter Hotez, an infectious disease expert and director of vaccine development at Texas Children’s Hospital.

Hundreds of thousands of Americans died because they didn’t get vaccinated against Covid-19, he said, and big rises in preventable illnesses such as whooping cough and measles have become “imminent threats to the health of the American people.”

“It’s so dangerous for the country, and now it’s deadly,” Hotez said. “That’s going to continue to be one of our big challenges in uncoupling the anti-science from politics.”

The way a public health leader assesses scientific data on vaccines is an “important litmus test,” said Dr. Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health.

“It shows how someone makes decisions about complex, high-stakes issues and what level of evidence and rigor someone insists upon when making those decisions,” she said. “When you see someone who says there is no safe and effective vaccine, and that statement is so at odds with all of the evidence we have, that really makes you question the judgment and character of the person who is making that statement. In my view, that is disqualifying for any serious governmental position.”

Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said Weldon’s efforts in Congress worry him.

“I think it’s very concerning that [the] potential next chief of the CDC is someone who has been a purveyor of vaccine misinformation, particularly relating to the preservative [thimerosal],” Adalja wrote in an email, referring to the disproven belief that the preservative is linked to autism. “It requires a high degree of an evasion, especially in a physician, to accept fallacious ideas that lead people to diminish their acceptance of what is probably one of humankinds greatest technological developments.”

Weldon’s partisan past and hazy present
“Who?” Is the most common reaction Dr. Brian Castrucci said he’s heard in response to Weldon’s nomination to lead the CDC.

“To the best of anyone’s knowledge, [Weldon has] not had much interactions or experience working in a health department. It doesn’t seem that he has much experience working in working in the field of public health,” said Castrucci, an epidemiologist who is president and CEO of the de Beaumont Foundation, a nonprofit focused on strengthening the US public health system.

“I think, unfortunately, given who may have been the nominee, there’s almost a sigh of relief, and somehow, not knowing who this person is is acceptable over some of the folks that it could have been. That’s not good enough for me,” Castrucci said.

Weldon served 14 years in Congress, representing a Florida district near Tampa from 1995 to 2009.

In 2007, Weldon introduced the Vaccine Safety and Public Confidence Assurance Act, which aimed to create an “Agency for Vaccine Safety Evaluation” within HHS, independent of the CDC. “The Centers for Disease Control and Prevention is responsible for promoting both high immunization rates and vaccine safety, duties perceived by some to constitute a conflict of interest,” the legislation noted.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, recalled a run-in with Weldon during his time on the CDC’s Advisory Committee for Immunization Practices, a board of independent experts who advise the agency on how to use vaccines to control diseases.

He said Weldon “believed strongly that [the measles, mumps and rubella vaccine] was the cause of autism. And he believed … that if you separate that vaccine into its three component parts, that you can avoid autism, which, of course, is absurd, because already studies had shown that you were at no greater risk of autism if you’d gotten that vaccine or you hadn’t.”

But Weldon’s position at the time on the House Appropriations Committee, on which the CDC depended for government funding, “essentially forced a vote” on whether to give the vaccine as three instead of one, Offit recalled. Studies had already showed that this had nothing to do with autism, Offit said, so “It was embarrassing.”

“And Weldon got what he wanted,” Offit said. “Because the way that story was carried was that we were discussing this like this was actually a real thing to consider, when it wasn’t.

“These are science-based agencies. They depend on good science to move forward. And when you have someone who has a series of fixed beliefs that they hold with the strength of religious convictions, that’s dangerous.”

If Kennedy and Weldon are confirmed, Offit said, “I think that there is every reason to believe that there will be a dismantling of the way that we perceive and administer vaccines in this country, and that that will cause a decrease in vaccine rates, and the first disease to come back is measles. And I think that we will make measles great again, and thousands of cases will result in some children dying from a disease that’s preventable.”

Hotez says that Weldon’s name hasn’t been on his radar for more than a decade and a half and that it will be important to hear at the confirmation hearing whether his stance has changed.

CDC directors were formerly appointed by the president, but the position will be subject to Senate confirmation beginning in January.

More unknowns
There is more to learn about Makary and Nesheiwat, too. Neither responded to CNN’s requests for comment.

The US surgeon general typically serves as the voice of the administration’s public health policy while promoting their own agenda of issues that they feel are important to the health of American people.

Hotez says he was in regular conversation with Nesheiwat in the early days of the Covid-19 pandemic as leading public health voices in the media worked together to figure out how to process the onslaught of information and communicate effectively to the public. He said she was “open-minded and had an interest in really understanding and learning and being educated,” and that’s a good sign for how she would handle the surgeon general role.

Her regular appearances on Fox News have also “battle-tested” her ability to present solid health information without conforming to particular points of view, Hotez said. But he’s not sure what issues she might choose to promote in this high-profile role.

Other experts have called Makary a “contrarian” who has correctly made sharp critiques of FDA.

But Offit said he would prefer that Makary take a stronger stance against Kennedy’s anti-vaccine ideas.

“It worries me when people like Makary is in that position that he doesn’t say, ‘Don’t worry about it. I’m very much pro-vaccine. Nothing anti-vaccine is going to ever be part of the FDA.’ Make people feel better, instead of just trying to whitewash what RFK Jr. constantly says,” he said.

Health agencies such as CDC and the FDA typically have a degree of separation and independence from HHS, experts say, but it’s hard to know how much unorthodox influence Kennedy could exert if he heads the health agency.

A person familiar with Trump’s candidate search told CNN’s Kaitlan Collins that Kennedy played a key role in selecting the names to fill out the department, including the FDA commissioner and the CDC director.

“One hopes that anyone who gets tapped for a role does the work for the American people, on behalf of the American people, fulfilling the obligations of the office, and not necessarily the person who accommodated them,” Nuzzo said.

CNN’s Jacqueline Howard, Brenda Goodman and Meg Tirrell contributed to this report.

Thanksgiving week is here, and there’s a good chance your plans for the food-focused holiday are already in place. But if your plans to get the updated COVID-19 vaccine well before the holiday fell through, you may be wondering if it’s too late to get the shot before getting together with family and friends. Should you even bother?

Health officials have advised people to get the updated COVID-19 vaccine ahead of the holidays — at least two weeks before. However, if you’ve missed that deadline, it might still be beneficial to get the jab before you head off to your gatherings ― for multiple reasons.

For starters, there was a worldwide surge in COVID infections this past summer, and some health experts predicted that there might be another wave in the fall and winter months.

“The fall and winter months typically see a higher rate of respiratory viruses like [COVID-19] and influenza, as people are indoors and respiratory viruses like [COVID-19] seem to be able to survive or persist in the cooler temperatures, lower rates of humidity allow for the virus to be spread further,” Dr. Matthew Binnicker, the director of clinical virology at Mayo Clinic in Rochester, Minnesota, previously told HuffPost.

And last week, the Centers for Disease Control and Prevention released a report estimating that COVID-19 infections were growing, or likely growing, in eight states across the country.

Additionally, a majority of people in the U.S. may be feeling less and less inclined to get vaccinated. An October Pew Research Center survey found that 60% of Americans say they probably won’t get an updated 2024-25 COVID-19 vaccine. That means there may be a lot of people who are less protected from newer COVID variants this season.

All of those factors are reason enough to consider still getting the shot. But there’s a lot of important information to keep in mind when it comes to the updated vaccines, surges in infections and the constantly changing SARS-CoV-2 virus, which causes COVID-19. So if you’re still deciding whether or not it’s worth it to get the vaccine days before Thanksgiving, here’s what to know.

The most recent shot targets variants that have been infecting people this year.
The U.S. Food and Drug Administration approved three 2024-25 COVID-19 vaccines in August: the vaccines by Moderna and Pfizer-BioNTech, and the Novavax vaccine.

The updated COVID vaccines from Moderna and Pfizer target the KP.2 variant, which is one of several variants referred to as “FLiRT variants” that began spreading across the U.S. in the spring. The Novavax vaccine targets the JN.1 variant, which is the parent variant to the KP.2 strain. JN.1 was first detected in the U.S. in September 2023, according to the CDC.

The CDC recommends that everyone ages 6 months and older receive an updated 2024-25 COVID-19.

The Moderna and Pfizer-BioNTech vaccines are authorized for use from 6 months of age, but Novax is only authorized for people ages 12 and over.

Typically, it takes the vaccine two weeks to kick in, but it’ll last you a while after that.
Dr. David Wohl, an infectious diseases specialist at the University of North Carolina’s School of Medicine, previously told HuffPost that “it can take a good two weeks to get the full effect of the vaccine.”

So ideally, you would’ve gotten the updated COVID-19 vaccine by at least Nov. 14 this year to reap its full benefits before the Thanksgiving holiday.

But research also suggests that the shot’s effectiveness lasts for months after you receive it. The vaccines are most effective during the first three months post-vaccination, according to John Hopkins Medicine. And CDC data from early this year found that people who had received an updated COVID-19 vaccine were 54% less likely to get the disease during a four-month period after getting the shot in September 2023.

You should still get an updated COVID-19 vaccine, even if it’s a few days before Thanksgiving.
While you won’t get the full effectiveness of the vaccine in time for Thanksgiving, you can still benefit from getting vaccinated now.

Jennifer B. Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health, pointed out that getting the COVID-19 vaccination now “will likely provide extra protection during the end of December holidays.”

“The only downside I can think of to getting boosted now is if you typically experience normal but unpleasant symptoms after getting vaccinated, it could dampen your Thanksgiving cheer,” she told HuffPost. “But otherwise, I’d say you might as well get it done.”

“This is, of course, assuming you haven’t already had COVID this fall. If you did, then there’s probably [a] benefit to waiting three more months,” she added. (The CDC recommends waiting about three months after you had COVID-19 before getting vaccinated.)

Dr. Onyema Ogbuagu, a Yale Medicine infectious diseases physician and associate professor at Yale School of Medicine, also told HuffPost that while it’s “a bit too late at this point to benefit from full protection for the upcoming Thanksgiving period,” there is “no harm with getting the vaccine, as [the] post-Thanksgiving period still matters as we are in respiratory viral season.”

Ogbuagu emphasized that he feels particularly strongly that people ages 65 and older, as well as people with moderate to severe immunocompromising conditions, receive the updated COVID-19 vaccine, “as they stand the most to lose if they don’t and most to benefit if they do.”

Dr. Amesh A. Adalja, a senior scholar at Johns Hopkins Center for Health Security, also acknowledged that the immune system takes “some time” to develop high enough antibody levels to prevent infection after a person gets a COVID-19 shot, but recommends that individuals who are considered high-risk get the vaccine “as soon as possible” regardless, he told HuffPost.

You should also try to take some other healthy precautions.
Adalja said his recommendations for avoiding COVID depend on an individual’s risk factors for severe disease.

“COVID is an endemic respiratory virus, and it will be with us this Thanksgiving and future [Thanksgivings],” he said. “We have many tools to limit its impact, including home tests, antivirals, and updated vaccines.”

Ogbuagu added that while he knows “everyone is fatigued with masking,” it’s important that healthy people and younger adults who are sick stay away from vulnerable groups such as elderly people, people who are immunocompromised or those with underlying conditions like lung disease or asthma.

He recommended that people in the vulnerable category consider masking in “congregate settings” (like a Thanksgiving gathering in someone’s home). But he warned that masking without also including other protective measures, such as hand-washing or not eating in a closed and crowded space, would provide “limited benefit.”

“The most important thing you and your loved ones can do is stay home if you aren’t feeling well,” Nuzzo said. “To reduce your likelihood of picking up an infection en route, you may want to wear a mask when traveling by crowded plane, train or other mass transit.”

“If a large crowd is gathering indoors, making sure the space is well-ventilated can reduce the likelihood of spreading illnesses,” she added.

One of the biggest producers of raw milk had its product test positive for bird flu. What are the risks of drinking raw milk, and of bird flu in general?

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Credits
Guest: Jennifer Nuzzo - director, Pandemic Center, Brown University’s School of Public Health

Host: Madeleine Brand

Producers: Sarah Sweeney, Stephen Gregory, Angie Perrin, Amy Ta, Brian Hardzinski, Nihar Patel, Robin Estrin, Jack Ross

State health officials said Sunday that bird flu virus was detected in a retail sample of raw milk from the Fresno-based Raw Farm dairy.

The sample was collected by officials with the Santa Clara County public health office, who have been testing raw milk products from retail stores “as a second line of consumer protection.”

County officials identified the virus in “one sample of raw milk purchased at a retail outlet” on Nov. 21, according to statements from both the state and the county. The county contacted stores on Friday and recommended they pull the raw milk from sale. The test results were confirmed on Saturday by the California Animal Health and Food Safety Laboratory System at UC Davis.

“This isn’t surprising, given how quickly H5N1 seems to be spreading among farms in California and given the fact that these outbreaks on farms are being discovered in large part due to bulk testing of raw milk from farms,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I. “What we don’t know is how much risk H5N1 poses to people that drink unpasteurized, infected milk.”

The test was positive only for the “H5” part of the virus. However, health officials say an H5 finding in a California dairy product is likely H5N1. No other H5 bird flu viruses have been detected in dairy cows.

Raw Farm has issued a voluntary recall for all quart- and half-gallon-sized milk products produced on Nov. 9, with an expiration date of Nov. 27, with a lot ID of #20241109.

So far, there have been no reports of illness associated with this recall.

“Out of an abundance of caution, and due to the ongoing spread of bird flu in dairy cows, poultry, and sporadic human cases, consumers should not consume any of the affected raw milk,” wrote the state’s health officials in a statement.

Nuzzo said evidence from animal studies suggests the virus “could pose a risk if ingested in large enough quantities, but we have not yet seen human cases resulting from raw milk consumption. Given that ingestion of raw milk has no credible health benefits, I personally would avoid drinking it.”

Researchers have found that barn cats who drink raw milk tend to die as a result of their exposure. And laboratory studies have shown similar results.

Last week, the CDC reported samples taken from a child in Alameda County who was showing mild respiratory symptoms were positive for H5N1. It is unclear how the child was exposed to the virus, although investigators ruled out exposure to infected dairy or poultry animals. They also ruled out raw milk.

Throughout California, 29 people have tested positive for the virus, and all but one — the child in Alameda County — are dairy workers. Nationwide, the number is 55, with 32 exposed via dairy, 21 via poultry, and two with no known source.

In addition, a teenager in British Columbia was also infected, and has remained in critical condition for more than two weeks. The source of that child’s infection also remains unknown.

There is no evidence of person-to-person transmission of the virus.

Since March, 402 California dairy herds have tested positive in the state; 616 herds have tested positive nationwide.

Mark McAfee, the owner of Raw Farm, said that the testing he and the California Department of Food and Agriculture have conducted on his milk — since he started voluntary testing in late April — have all been negative.

“In the last two days CDFA has collected extra dairy samples from our farm bulk tanks and even retail samples and they are all officially Negative for HPAI,” he wrote in a statement. HPAI is the acronym for Highly Pathogenic Avian Influenza; it is often used interchangeably with H5N1, as well as other highly pathogenic bird influenza strains.

The California Department of Public Health confirmed that the agriculture department had tested McAfee’s milk after receiving news of the finding, and results were negative.

Raw Farm is the largest producer and retailer of raw milk in the state, where the product is legally sold in retail stores. McAfee said he has about 1,800 head of cattle on two dairies — one in Fresno, the other near Hanford.

The U.S. Food and Drug Administration does not allow for the interstate transfer of raw milk for human consumption, and advises the public not to drink or consume raw milk products. Officials say that pasteurization inactivates the virus.

Several states have recently changed laws to legalize raw milk products, including Iowa, Louisiana and Delaware — which all changed laws this spring allowing for wider consumer access.

In addition, President-elect Donald Trump’s nomination for Health and Human Services, Robert F. Kennedy, Jr., is a vocal proponent of raw milk and has said he wants to increase people’s access to unpasteurized milk.

The Raw Farm recall notice requests that stores remove the product from its shelves, and urges consumers to return the product to the store from which it was purchased for a free replacement or refund.

McAfee said it is unlikely any of the product remains on store shelves.

“It’s all gone,” he said. “We take back anything that doesn’t sell after seven days.”

The virus has shown up in wastewater sites across Santa Clara County, including Palo Alto, San Jose, Gilroy and Sunnyvale.

It’s also been detected in 24 of the 28 California wastewater systems tested by WastewaterScan — an infectious disease monitoring network led by researchers at Stanford, Emory University, with lab testing partner Verily, Alphabet Inc.’s life sciences organization.

We are living in a “very highly charged time for raw milk,” McAfee said. “It’s all over the news with RFK announcing he wants raw milk for everyone to improve the immunity and gut microbiome for America.”

“Our mission is to nourish our consumers with the highest quality raw milk and that is what we are doing,” he said, citing his testing protocol and history with the state’s agriculture department.

When the Trump administration arrives in Washington next year, it will be faced with an avian influenza outbreak that has already ravaged U.S. poultry operations and dairy farms, and poses a real risk of sparking a human pandemic.

A longtime leader of the anti-vaccine movement. A highly credentialed surgeon. A seven-term Florida congressman. A Fox News contributor with her own line of vitamins.

President-elect Donald J. Trump’s eclectic roster of figures to lead federal health agencies is almost complete — and with it, his vision for a sweeping overhaul is coming into focus.

Mr. Trump’s choices have varying backgrounds and public health views. But they have all pushed back against Covid policies or supported ideas that are outside the medical mainstream, including an opposition to vaccines. Together, they are a clear repudiation of business as usual.

“What they’re saying when they make these appointments is that we don’t trust the people who are there,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the Food and Drug Administration.

Some doctors and scientists are bracing themselves for the gutting of public health agencies, a loss of scientific expertise and the injection of politics into realms once reserved for academics. The result, they fear, could be worse health outcomes, more preventable deaths and a reduced ability to respond to looming health threats, like the next pandemic. “I’m very, very worried about the way that this all plays out,” Dr. Offit said.

But other experts who expressed concerns about anti-vaccine views at the helms of the nation’s health agencies said that some elements of the picks’ unorthodox approaches were welcomed. After a pandemic that closed schools across the country and killed more than one million Americans, many people have lost faith in science and medicine, surveys show. And even some prominent public health experts were critical of the agencies’ Covid missteps and muddled messaging on masks and testing.

“We are playing with fire with the shake-ups and choices, but at this point change is needed,” said Dr. Michael Mina, an epidemiologist and former Harvard professor. He said the agencies were often too slow and bureaucratic, and their leaders too unwilling to engage with the public’s concerns. “At least there’s a better chance of positive change compared to complacency and more of the same,” he said.

One thing seems certain: It will not be more of the same.

In the final months of Mr. Trump’s campaign, he brought Robert F. Kennedy Jr. aboard with the message that a total remake of the nation’s public health system was the only way, as Mr. Kennedy’s own presidential campaign slogan put it, to “Make America Healthy Again.”

Less than two weeks after the election, Mr. Kennedy was tapped to lead the Health and Human Services Department, a sprawling federal agency that includes the Centers for Disease Control and Prevention, the F.D.A. and the National Institutes of Health, and also oversees Medicare and Medicaid.

Mr. Kennedy, an environmental lawyer, has a long track record of spreading falsehoods about vaccines and using his nonprofit, Children’s Health Defense, to promote a database of misleading interpretations of research data. He once asserted publicly that “there’s no vaccine that is, you know, safe and effective.”

He was Mr. Trump’s first public health pick, and, experts said, he remains his most dangerous one.

Mr. Kennedy “is just in a category by himself,” said Jennifer Nuzzo, the director of the Pandemic Center at Brown University. “R.F.K. Jr. just willfully disregards existing evidence, relies on talking points that have been consistently debunked.”

If confirmed by the Senate, Mr. Kennedy would oversee the agencies that regulate vaccines and set national vaccine policy — and the heads of those agencies would report to him. “He will have enormous influence,” said Dr. Ashish Jha, dean of the Brown University School of Public Health, who oversaw the Biden administration’s response to the coronavirus pandemic.

Dr. David Weldon, Mr. Trump’s pick to lead the C.D.C., has also promoted anti-vaccine views. An internist by training, Dr. Weldon served seven terms in Congress, representing a district on Florida’s central east coast, before returning to his medical practice.

While in Congress, Dr. Weldon was known for pushing the false notion that thimerosal, a preservative compound in some vaccines, had caused an explosion of autism cases.

“The notion that this man who held a series of false beliefs about science and medicine could rise to the position where he would head the C.D.C. is in some sense frightening,” Dr. Offit said.

Dr. Weldon also introduced a “vaccine safety bill” in 2007 that aimed to relocate most vaccine safety research from the C.D.C. to a separate agency within the Health and Human Services Department. The bill did not advance out of committee. The question is whether Dr. Weldon will bring similar aspirations with him back to Washington, persuading Congress to narrow the reach of his own agency.

Some of the most extreme anti-vaccine policies, such as an outright ban on certain shots, would be difficult, if not impossible, to put in place, experts said. And pharmaceutical companies are poised to push back — hard — on any policies that would threaten their vaccine business.

Mr. Trump’s choice for F.D.A. commissioner, Dr. Martin Makary — a pancreatic surgeon at the Johns Hopkins School of Medicine — has been broadly supportive of childhood vaccines. But he has questioned the benefits of certain shots, including the hepatitis B vaccine for newborns and a third Covid booster shot for healthy children. “I think there are questions that we can ask that have been taboo to ask,” he told The Wall Street Journal.

If confirmed, he would direct the agency that approves new flu and Covid vaccines each year and monitors reports about vaccine side effects.

Dr. Makary has become known — in opinion articles and on podcasts and spots on Fox News — for critiquing vaccine mandates and many other parts of U.S. Covid policies, and for arguing that doctors have underestimated natural immunity.

Dr. Nuzzo, who was once a colleague of Dr. Makary’s at Johns Hopkins, said that while she disagreed with some of his views, she believed that he was qualified for the position.

“I believe Marty is a man of science,” she said. “I think he will look at the scientific evidence carefully and interpret it using the training and skills that he has.”

But how much Dr. Makary would be able to separate himself from Mr. Kennedy remains an open question. “How does he withstand the pressure of an H.H.S. secretary who fundamentally doesn’t believe in modern medicine?” Dr. Jha asked.

Mr. Trump’s pick for surgeon general is Dr. Janette Nesheiwat, a medical director of CityMD, a chain of urgent care centers. Dr. Nesheiwat, who was also a Fox News contributor, provided on-the-ground medical treatment after Hurricane Katrina and a 2011 tornado that struck Joplin, Mo., according to a statement from Mr. Trump.

She was generally supportive of the Covid vaccines, calling them “a gift from God” in a 2021 opinion article for Fox News. But she has opposed Covid vaccine mandates and argued against the dismissal of soldiers who refused to be vaccinated.

Her upcoming book, “Beyond the Stethoscope: Miracles in Medicine,” shows the “transformative power of prayer,” according to a description on the publisher’s website. She also sells her own line of dietary supplements.

Dr. Nesheiwat’s sister Julia Nesheiwat was homeland security adviser in the first Trump administration and is married to Representative Michael Waltz, Republican of Florida, Mr. Trump’s pick for national security adviser.

Surgeons general have historically had little power, but have tended to use their position to draw attention to their public health priorities. President Biden’s surgeon general, Dr. Vivek Murthy, has lately warned about the dangers of social media.

“I feel pretty good about the appointment of the surgeon general,” said Dr. Peter Hotez, a vaccine expert at the Baylor School of Medicine in Houston. “I’ve spoken to her many times and texted her during the pandemic. She’s open-minded, thoughtful and is evidence-based.”

Although high-level staffing picks set the tone, what happens to the nation’s public health system will also depend on Trump administration decisions that are still to come.

Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said that he would be keeping a close eye on lower-level appointees — those who carry out the day-to-day work of these agencies. He is also especially concerned about the possibility that the administration will move to fire the federal scientists working as civil servants.

“Everything that we have so far points to some radical changes that are about to occur,” Dr. Osterholm said.

Emily Anthes is a science reporter, writing primarily about animal health and science. She also covered the coronavirus pandemic. More about Emily Anthes

Emily Baumgaertner is a national health reporter for The Times, focusing on public health issues that primarily affect vulnerable communities. More about Emily Baumgaertner

n 27 September 2024, Rwanda’s Health Ministry confirmed the country’s first ever Marburg virus outbreak. It was a distressing national moment: a filovirus like Ebola, Marburg is lethal with fatality rates of up to 88%. Symptoms are dreadful, including intense feverishness, acute headaches, vomiting and bleeding from the eyes, gums and elsewhere – “bad news wrapped up in protein” as Nobel Laureate biologist Peter Medawar put it in 1974.

Six weeks later, on 15 November 2024, Rwanda’s Minister of Health Dr Sabin Nsanzimana, announced the discharge of the last of the Marburg patients. The virus sadly caused 15 early deaths, but of the 66 cases, 55 patients recovered.

He noted that it had been 48 days since the first case was reported, two weeks since the last new case and a month without further fatalities. If no new infections arise 42 days after the last case tests negative, the outbreak will be declared over by December 21.

It is an admirable achievement by any measure. In a context where the recent US presidential election and the controversial cabinet and agency nominations drive the news cycle, it is important to heighten the visibility of Rwanda’s achievement, of how a lower-middle-income country in mid Africa managed to contain an outbreak caused by one of the world’s most feared high-consequence pathogens.

What happened in Rwanda is captured by Louis Pasteur’s famous aphorism that “chance favours the prepared mind” or, as in this instance, the prepared response system.

In 2008, when Nelson Mandela hosted Nobel Laureate David Baltimore to give a science lecture on the origins of HIV, Baltimore travelled to South Africa via Rwanda at the invitation of President Paul Kagame where he was asked — far-sightedly — to give the country’s leaders advice on how to ground development in science.

In 2018 Rwanda was one of the first countries to conduct the World Health Organization’s Joint Evaluation Exercises in pandemic preparedness and response, which assessed the most critical gaps in their human and animal health systems and prioritised opportunities for enhanced preparedness, detection and response within the framework established by the 2005 International Health Regulations.
A National Action Plan for Health Security, a roadmap to strengthen the International Health Regulations’ core capacities, followed the Joint Evaluation Exercises. The Rwandan government, through its Ministry of Health and Rwanda Biomedical Centre, worked tirelessly to tick all the points by ensuring the readiness and the resilience of the system for any outbreak. The implementation was smooth and ready.

Rapid response
When Covid-19 hit, Rwanda responded quickly. The authorities imposed a six-week lockdown and introduced contact tracing and other interventions — 82% of the population received at least one dose of a Covid-19 vaccine.

The Australian think tank the Lowy Institute ranked 98 countries for their Covid-19 response and found that smaller populations and capable institutions were the most important factors in managing the global pandemic. Rwanda was the only African country in the top 10 achievers.

Rwanda therefore had been working hard over the long haul to upscale their preparedness. The hospital-based surveillance system gave an alert that triggered the national public health institute — the Rwanda Biomedical Centre — to detect the Marburg virus, which in turn switched on contact tracing, diagnostics and case management.

Co-infection with malaria (Marburg/Ebola share symptoms with malaria) slowed down detection of the first case. However, diagnostics were quickly scaled up and 7,408 tests were administered with a focus on healthcare workers who suffered 80% of the infections.

Epidemiologists ultimately traced the first case back to a 27-year-old mining cave worker. He was exposed to the reservoir of Marburg virus, the fruit bat Rousettus, and subsequently infected his pregnant wife who was admitted to the King Faisal Hospital’s ICU in Kigali.

In the following days, many healthcare workers were infected and fell ill. Rwanda has a sizeable and growing mining industry, and is a major exporter of the so-called 3Ts — tin, tantalum, tungsten — and increasingly gold. Some of the mines are close to Rwanda’s extensive network of 52 caves, some 2km long, many of which have large bat colonies.

At King Faisal and the rapidly deployed Marburg Treatment Centre at Baho International Hospital, patients received prompt intensive care support; use of high flow nasal canula; and intravenous fluids to manage high fever, nausea, vomiting and diarrhoea. Intubation and life support were provided to patients experiencing multiple organ failure. Two Marburg patients were extubated i.e. taken off life support, the first time in Africa.

Infection control measures were implemented in hospitals, including personal protective gear distributed to all health workers. Rwandan officials monitored the health of more than 1,000 community members and engaged in door-to-door surveillance in exposed neighbourhoods.

Schools and hospital visits were suspended and the number of people who could attend Marburg funerals was restricted. Even with relatively prompt detection, most of the deaths were of exposed healthcare workers.

The WHO supplied 12,000 personal protective items, sufficient to run the specially built 50-bed Marburg Treatment Centre with its clinical isolation units for 30 days. A joint WHO and Rwandan Ministry of Health infection prevention and control team trained 520 healthcare workers in infection control and prevention.

Gilead Sciences, a global biopharmaceutical company that revolutionised HIV treatment and prevention, donated 5,100 vials of remdesivir, a broad-spectrum antiviral medication previously used to treat Covid-19, as an emergency treatment measure.

With support from the United States’ Biomedical Advanced Research and Development Authority, Mapp Biopharmaceutical deployed a monoclonal antibody MBP091 that targets the Marburg virus. Almost all the initial doses were given to healthcare workers.

‘Ring vaccination’ strategy
The Sabin Vaccine Institute donated more than 1,700 doses of an investigational Marburg Phase II clinical trial vaccine (manufactured by the company ReiThera) to administer to high-risk groups, including healthcare workers, mine workers (exposed to virus-carrying bats in caves in mining districts), and individuals in contact with confirmed cases. Half received the vaccine immediately, and the other half 21 days later to align with the end of the disease’s incubation period. The “ring vaccination” strategy was deployed.

Marburg vaccine efforts must be seen against the background of a major effort under way to establish Rwanda as one of Africa’s leading vaccine manufacturers. BioNTech opened its first modular messenger mRNA vaccine manufacturing facilities in Kigali in April 2024.

The Coalition for Epidemic Preparedness Innovation landed its 100 Day Mission there, working with IQVIA (clinical trials), Ginkgo BioWorks (wastewater surveillance), the Rwanda Biomedical Centre and the Rwanda Development Board on end-to-end vaccine manufacturing prospects.

Regionally, Africa Centres for Disease Control and Prevention dispatched a team of experts on 29 September to aid response efforts. In collaboration with Rwanda’s neighbours — Burundi, Uganda, Tanzania and the Democratic Republic of the Congo — Africa Centres for Disease Control and Prevention provided guidance on regional surveillance and containment strategies.

It cautioned against using travel bans and movement restrictions targeted at African countries as inconsistent with international health guidelines that undermine public health responses, deepen economic challenges, ignite inequities and prompt mistrust.

Instead, what is required is the harmonisation of regional and global policies when an outbreak like this occurs.

Finally, there is the critical asset of leadership, with President Paul Kagame and his cabinet members, and Dr Sabin Nsanzimana, an epidemiologist and former director-general of the Rwanda Biomedical Centre, in command of the effort.

WHO Director-General Tedros Ghebreyesus praised Rwanda for its response, noting that “leadership from the highest levels of government is essential in any outbreak response, and that’s what we see here in Rwanda”. To symbolise Rwanda’s partnership with the continent-wide public health technical support agency the Africa Centres for Disease Control and Prevention, Dr Nsanzimana held his press briefings jointly with its director-general, Dr Jean Kaseya.

Even so, we can do even better, and we must learn much more. Rwanda’s response was exceptional, but it wasn’t perfect. Disease detection could have been much faster. The virus spread in the hospital before being picked up.

We need to get on top of the ecology and migration patterns of the bat carrying Marburg and other viruses, and better understand the impact of rising temperatures, altered rainfall patterns and habitat loss due to mining and human incursions that drive bats to new areas in search of food and shelter.

Climate affects food availability and causes nutritional stress, disrupts hibernation and breeding patterns, and droughts and floods can drive bats closer to human settlements, all opportunities for greater viral transmission. Upscaled surveillance of the pathogens, the disease and the ecology of bats can create a knowledge base for better interventions.

It is not a stretch to say that the world — including the developed world — can learn a great deal from Rwanda. This is the true meaning of global health, an exchange of knowledge, expertise and best practice between North and South, not one-way traffic from North to South. DM

Wilmot James is a Professor at the School of Public Health and Senior Advisor; Craig Spencer a Professor in the School of Public Health; Anne Wang a Research Assistant; and Bentley Holt Assistant Director of Communications and Outreach at the Pandemic Centre, Brown University, Providence, Rhode Island, USA.

Edson Rwagasore is the Division Manager of Public Health Surveillance and Emergency Preparedness and Response, Rwanda Biomedical Centre, Kigali.

Jeanine Condo is an Adjunct Associate Professor at the University of Rwanda and Tulane University and CEO of the Centre for Impact, Innovation and Capacity Building for Health Information and Nutrition, Kigali.

Robert F. Kennedy Jr. has been picked by Donald Trump to lead the Department of Health and Human Services. Kennedy has been critical of processed food, vaccines, and fluoride in water. What impact could he have on the nation’s health?

Guests
Christopher Gardner, food science researcher. Director of nutrition studies at the Stanford Prevention Research Center. Rehnborg Farquhar professor of medicine at Stanford University.

Jennifer Nuzzo, director of the Pandemic Center and professor of epidemiology at the Brown University School of Public Health.

Vani Hari, food health activist. Social media influencer known as Foodbabe.

Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention. Currently president and CEO of Resolve to Save Lives, a public health nonprofit.

This program aired on November 21, 2024.

California health officials reported Tuesday that a child in Alameda County tested positive for H5 bird flu last week.

The source of infection is not known — although health officials are looking into possible contact with wild birds — and the child is recovering at home with mild upper respiratory symptoms.

Health officials have confirmed the "H5" part of the virus, not the "N1." There is no human "H5" flu; it is only associated with birds.

The child was treated with antiviral medication, and the sample was sent to the U.S. Centers for Disease Control and Prevention for confirmatory testing.

The initial test showed low levels of the virus and, according to the state health agency, testing four days later showed no virus.

"The more cases we find that have no known exposure make it difficult to prevent additional" infections, said Jennifer Nuzzo, professor of epidemiology and director of the Brown University School of Public Health's Pandemic Center. "It worries me greatly that this virus is popping up in more and more places and that we keep being surprised by infections in people whom we wouldn't think would be at high risk of being exposed to the virus."

Read more: Canadian teenager infected with H5N1 bird flu in critical condition

A statement from the California Department of Public Health said that none of the child's family members have the virus, although they, too, had mild respiratory symptoms. They are also being treated with antiviral medication.

The child attended a day care while displaying symptoms. People the child may have had contact with have been notified and are being offered preventative antiviral medication and testing.

“It’s natural for people to be concerned, and we want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious — and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said CDPH Director and State Public Health Officer Dr. Tomás Aragón.

The case comes days after the state health agency announced the discovery of six new bird flu cases, all in dairy workers. The total number of confirmed human cases in California is 27. This new case will bring it to 28, if confirmed. This is the first human case in California that is not associated with the dairy industry.

The total number of confirmed human cases in the U.S., including the Alameda County child, now stands at 54. Thirty-one are associated with dairy industry, 21 with the poultry industry, and now two with unknown sources.

In Canada, a teenager is in critical condition with the disease. The source of that child's infection is also unknown.

Genetic sequencing of the Canadian teenager's virus shows mutations that may make it more efficient at moving between people. The Canadian virus is also a variant of H5N1 that has been associated with migrating wild birds, not cattle.

Genetic sequencing of the California child's virus has not been released, so it is unclear if it is of wild bird origin, or the one moving through the state's dairy herds.

In addition, WastewaterScan — an infectious disease monitoring network led by researchers from Stanford University and Emory University, with laboratory support from Verily, Alphabet Inc.’s life sciences organization — follows 28 wastewater sites in California. All but six have shown detectable amounts of H5 in the last couple of weeks.

There are no monitoring sites in Alameda Co., but positive hits have been found in several Bay Area wastewater districts, including San Francisco, Redwood City, Sunnyvale, San Jose and Napa.

"This just makes the work of protecting people from this virus and preventing it from mutating to cause a pandemic that much harder," said Nuzzo.

For years, Robert F. Kennedy Jr., has leveraged his famous name, his celebrity connections and his nonprofit, Children’s Health Defense, to spread misinformation about vaccines and call their safety and efficacy into question. Soon, he might have the power to go much further.

If Mr. Kennedy is confirmed by the Senate to be secretary of health and human services, he would be in charge of the nation’s pre-eminent public health and scientific agencies, including those responsible for regulating vaccines and setting national vaccine policy.

Legal and public health experts agree that he would not have the authority to take some of the most severe actions, such as unilaterally banning vaccines, which Mr. Kennedy has said he has no intention of doing.

“I’m not going to take anyone’s vaccines away from them,” he wrote on social media last month. “I just want to be sure every American knows the safety profile, the risk profile, and the efficacy of each vaccine.”

But Mr. Kennedy, who has said that he wants federal researchers to pull back from studying infectious diseases, could exert his influence in many other ways. His actions could reduce vaccination rates, delay the development of new vaccines and undermine public confidence in a critical public health tool.

In the last three decades alone, childhood vaccines have prevented more than 500 million cases of disease, 32 million hospitalizations and more than one million deaths in the United States, according to a recent report from the Centers for Disease Control and Prevention. But vaccination rates have been falling in recently years, and Mr. Kennedy could accelerate the trend, public health experts said.

“A lot of damage is possible,” said Dr. Thomas Frieden, a former director of the C.D.C. who now leads Resolve to Save Lives, a public health nonprofit. “The secretary of health has a life-or-death responsibility. And if unscientific statements and decisions are made, if agencies are damaged, if public confidence is undermined, then you can get spread of disease.”

Here are five things Mr. Kennedy could do.

He could revise the government’s vaccine recommendations.
As the federal health secretary, Mr. Kennedy would oversee the C.D.C., the agency that issues guidance on which immunizations Americans should get and when.

Health insurers look to those recommendations to determine what vaccines to cover and state health departments use them to inform their own vaccine policies.

Mr. Kennedy would have final say over which experts sit on the external committee that advises the C.D.C. on vaccines, and he would be the boss of the C.D.C. director, who decides whether to adopt that guidance. “That’s, in my mind, a recipe for a disaster,” said Lawrence O. Gostin, an expert in public health law at Georgetown University.

A C.D.C. director or advisory committee that is hesitant toward vaccines could usher in changes in the childhood vaccine schedule, such as removing vaccines from the list of recommended immunizations or changing the ages at which they are advised.

“If the question is purely, could the H.H.S. secretary unilaterally remove vaccines from a schedule or alter the schedule, I think the answer to that would ultimately be no,” said Dr. Michael Mina, an epidemiologist and former professor at Harvard University. “But with a little bit of planning, through like-minded appointments and top-down pressure, the answer to that starts to move the needle toward yes.”

One thing he could not do is abolish vaccine mandates, such as requirements that children receive certain immunizations before attending school. Those are set by state and local governments. The federal health secretary does not have the authority to override them.

But some public health experts fear that some state health authorities, particularly in Republican-led states, could follow a C.D.C. that is skeptical of vaccines. One result might be lower vaccination rates — and worse public health outcomes — in red states than in blue ones, Mr. Gostin said, similar to the pattern that played out with the Covid-19 vaccines.

He could slow vaccine development and approval.
Mr. Kennedy would also be in charge of the F.D.A., the agency responsible for approving new vaccines.

He has repeatedly criticized the agency, which fast-tracked the authorization of the Covid-19 vaccines, as well as the shots themselves. As health secretary, he would not be able to remove them or any other already authorized vaccines from the market without strong scientific evidence, Mr. Gostin said. If he tried, vaccine manufacturers could sue over such a decision and courts would most likely rule in their favor, he said.

But he could bring people who share his views into the F.D.A. Together, they could make the process for approving new vaccines more onerous and lengthy, including requiring more data.

“He could say, ‘I don’t think this has been studied in the right way,’” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the F.D.A.

He could also stop or slow vaccine development research conducted at or funded by the National Institutes of Health, the federal government’s top medical research agency, which would also fall under his purview. He has been clear about his plans to empty some divisions that focus on advancing vaccine research and development. He has said he would fight the next pandemic instead by “building people’s immune systems.”

“I’m going to say to N.I.H. scientists, ‘God bless you all,’” Mr. Kennedy said as a presidential candidate last November. “‘Thank you for public service.’ We’re going to give infectious disease a break for about eight years.”

Infectious diseases are still looming, however. And a slowdown in vaccine research, development or approval could have particularly dire consequences in the event of another public health emergency like Covid-19.

Bird flu, for instance, continues to infect American farm workers, and experts have worried that the virus could evolve to spread more easily among humans. If that happened, “we would be in a new pandemic,” said Jennifer Nuzzo, the director of the Pandemic Center at Brown University. “And that pandemic would move very quickly. Any attempt to not act with urgency would be deadly.”

He could emphasize vaccine side effects.
Decades of scientific study confirm that the benefits of vaccines far outweigh the risks, but like all medications, they carry the possibility of side effects, including some rare but serious ones. Mr. Kennedy — who has said he wants more public visibility into safety data — is poised to draw outsize attention to adverse outcomes.

His nonprofit promotes a database of research that includes hundreds of misleading interpretations of vaccine data. In September, the group released “Vaxxed 3: Authorized to Kill,” a film claiming that Covid vaccines led to “tragic outcomes of either death or serious injury.”
Under Mr. Kennedy, federal agencies like the F.D.A. could highlight potential side effects by requiring vaccine makers to list even very rare ones on the packaging label.

Mr. Kennedy could also draw attention to unverified reports of adverse events collected by federal agencies. “What I would worry about is an abuse of the data,” said Dr. Peter Lurie, the president of the Center for Science in the Public Interest and a former associate commissioner at the F.D.A.

Mr. Kennedy could also push federal agencies to conduct more research into vaccine safety. That would not be a bad thing in itself, said Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and an adviser to the F.D.A. “There is more research that can be done, particularly on some of the newer vaccines,” he said.

But, the research must be scientifically rigorous, he added, and build upon decades of scientific evidence related to vaccine safety. “If you signal this to the public as, ‘Well, we have to start from scratch, all of these vaccines are suspect,’ I would disagree with that approach,” Dr. Levy said. “Because many of these vaccines have been very, very well studied, and they’re a huge win for kids.”

He could weaken legal protections for vaccine makers.
Under a longstanding federal law, people who experience serious side effects after receiving certain routine vaccinations are limited in their ability to sue drug companies. Instead, they can seek compensation through a government-run program. The law is intended to encourage drug companies to invest in vaccine development.

Mr. Kennedy could not make major changes to the law without congressional approval, but he could remove specific vaccines from the program. Whether he could take every vaccine off the list is “difficult to say, because it’s uncharted waters, legally speaking,” said Ana Santos Rutschman, an expert on health law and policy at Villanova University.

If vaccines are removed from the program, some companies may decide to stop making them. “And that’s going to have two effects: driving vaccine costs up and reducing availability for those who want the vaccines,” said Dorit Reiss, an expert on vaccine policy and law at the University of California College of the Law, San Francisco.

(And because the program is more favorable to plaintiffs than the courts are, paring down the list could actually make it more difficult for people with vaccine injuries to be compensated, Dr. Reiss added.)

A more recent law also provides liability protections to companies making vaccines for public health emergencies, such as the Covid-19 pandemic. These protections are put in place by a declaration from the secretary of health; in the event of another pandemic, Mr. Kennedy could simply refrain from making one.

Over the longer term, experts said, weakening the liability protections would probably prompt some pharmaceutical companies to abandon vaccine development. “Which, from a public health perspective, may mean fewer vaccines in the future,” Ms. Rutschman said.

He could speak out against vaccines.
Many experts say they worry most about Mr. Kennedy’s bully pulpit. If confirmed, Mr. Kennedy would have a new platform for spreading misinformation about vaccines and amplifying fears about their safety.

“It’s very hard to claw back outrageous ideas when social media algorithms propel them forward,” Dr. Nuzzo said.

Vaccine hesitancy grew during Mr. Trump’s first term as president and persisted after he left office.

Vaccine experts have said that Mr. Kennedy is particularly skilled at taking good, peer-reviewed science and skewing the findings.

Dr. Mina said he expected Mr. Kennedy to “to do exactly what he’s been doing for years: fudging the way that data is meant to be interpreted, using very manipulative tactics to drive a message that makes vaccines look dangerous. He is a master at it — truly a master.”

During a measles outbreak in Samoa in 2019, Mr. Kennedy stoked the skepticism driving the spread. He wrote to the nation’s prime minister on the Children’s Health Defense letterhead, suggesting that the failure of vaccines given to pregnant women and children was the true culprit. More than 50 children died in the outbreak.

RFK Jr. is ‘exactly the wrong pick’ for HHS secretary

Dr. Jennifer Nuzzo, director of Brown University’s Pandemic Center, criticizes President-elect Donald Trump's pick for Health and Human Services secretary.

November 15, 2024

Canadian health officials announced Tuesday that a teenager infected with H5N1 bird flu from an unknown source is in critical condition.

According to British Columbia Provincial Health Officer Bonnie Henry, the child is suffering from acute respiratory distress and was hospitalized on Friday.

The teen is the first presumptive case of H5N1 bird flu in Canada.

“Our thoughts continue to be with this person and their family,” said Henry.

Authorities believe the virus was acquired via an animal source; however, the teen was not on a farm nor near any known wild birds or backyard poultry — common reservoirs for the disease.

According to a CBC interview with Henry, the teen did not have any contact with birds but did interact with a variety of other animals — including a dog, cats and reptiles — in the days before becoming ill. Testing on those animals has so far been negative.

The health authorities are also tracing people the teen was in contact with; so far they have not identified other infections.

The situation is “horrifying,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University. “The idea that we have a child, a teenager, who is seriously ill from this virus is just really an utter tragedy. But sadly, it’s not surprising, given everything we’ve known about H5N1 and its potential to cause illness.”

She noted that since the late 1990s, when this current strain of bird flu originated in China’s Guangdong province, the fatality rate was close to 60%. That number is likely inflated, she said, as presumably most people tested for the disease were those who went to hospitals or clinics to seek treatment; people who had mild symptoms, or were asymptomatic, were likely not tested.

Nevertheless, Nuzzo said, while this virus could “be a lot less deadly than what we’ve seen to date,” it could still be far more deadly than any pandemic we’ve seen in a long time, including COVID.

She said the case causes her concern for three reasons: The first is the severity of the teen’s illness. The second is that “we don’t understand how the teenager got infected,” she said. Her third concern is how government officials are dealing with this outbreak, which she described as “letting it continue to spread from animals to people, without trying to do more to get ahead of it.”

She said the virus may in the end not end up becoming more virulent or efficient at moving between people, “but I don’t think we want to wait around and on the chance that it might.”

Since the virus appeared in North American wild birds in 2021, human cases have mostly presented as mild. Since 2022, there have been 47 human cases in the U.S. — 25 in dairy workers, 21 in poultry workers, and one case in Missouri where the source has not yet been identified.

However, a recent study from the U.S. Centers for Disease Control and Prevention shows the virus is more widespread in dairy workers than had previously been assumed. An examination of antibodies in 115 dairy workers from Michigan and Colorado showed that eight people were positive for the disease, or 7% of the study population — indicating that either workers were not reporting illness, or they were asymptomatic.

Nuzzo also pointed to a recent study published in Nature, led by Yoshihiro Kawaoka, an H5N1 expert at the University of Wisconsin, in Madison, that showed the virus that infected the first reported dairy worker in Texas had acquired mutations that made it more severe in animals as well as allowing it to move more efficiently between them — via airborne respiration.

When Kawoaka exposed ferrets to this viral isolate, 100% died. In addition, the amount of virus they were initially exposed to didn’t seem to matter. Even very low doses caused mortality.

Kawoaka told The Times in an interview that the mutations seen in this particular isolate have appeared elsewhere in past outbreaks in birds and mammals, “so in that sense, it’s a very orthodox mutation.”

On Wednesday, Canadian health authorities announced they had genetically sequenced the virus in the teen, and it is the newer D1.1 version that has affected poultry flocks in the Pacific Northwest this fall, and was likely carried by wild birds migrating south. It is not the version being seen in dairy cows or dairy workers, which has been called B3.13. Both are of the H5N1 2.3.4.4b clade that has been wreaking havoc across North and South America since 2021, and in Europe, Asia and Africa since 2020.

Fortunately, the mutated isolate that infected the lone dairy worker in Texas has not been seen since. It’s unclear why the worker did not present with more severe symptoms.

However, there are a few hypotheses.

Kawaoka’s research shows “inefficient replication” of the virus in human corneal cells. If the worker was exposed by a splash of contaminated milk to the eye, or a rub of the eye with a contaminated glove, the virus may have been stalled out — unable to replicate like it could have had the worker been exposed via inhalation.

Nuzzo said there are other hypotheses — which she stressed are just hypotheses — including one that posits people who were exposed to the H1N1 swine flu outbreak in 2009 may have acquired some immunity to the “N1” part of the virus.

The other goes back to a person’s first influenza exposure.

There is a scientific hypothesis called the “original antigenic sin” that suggests that a person’s first exposure to a particular virus “may sort of kind of set the tone” for that person’s immune system going forward — so this worker’s first flu exposure may have provided his immune system with the defenses needed to suppress H5N1.

“There are a lot more questions than answers at this point. So there are a lot of interesting hypotheses for why the more recent cases have been mild, there’s not enough evidence to simply discard more than two decades worth of evidence about this virus that tells us that it could be quite deadly,” said Nuzzo.

As human flu season ramps up, Nuzzo said it’s critically important that people do what they can to prevent the spread of disease.

She said both seasonal flu and H5N1 vaccines should be provided to dairy workers.

Unfortunately, she said, “our surveillance efforts for trying to find outbreaks on farms, while getting better, are still not even close to what we need to know about these outbreaks.”

In the meantime, vaccines and antiviral medications need to be on hand.

“The news of a deeply serious human case of bird flu is a massive wake-up call that should immediately mobilize efforts to prevent another human pandemic,” said Farm Forward Executive Director Andrew deCoriolis. “We could have prevented the spread of bird flu on poultry farms across America, and we didn’t. We could have prevented the spread of bird flu on dairy farms, and we didn’t.”

“Factory farms notorious for raising billions of sickly animals in filthy, cramped conditions provide a recipe for viruses like bird flu (H5N1) to emerge and spread,” said deCoriolis in a statement. “We are now on the cusp of another pandemic and the agencies responsible for regulating farms and protecting public health are moving slower than the virus is spreading.”

As of Wednesday, there have been 492 dairy herds infected with H5N1 across 15 states. More than half, 278, are in California. Two pigs in Oregon have also been infected.

A Canadian teenager is hospitalized in critical condition with bird flu, health officials reported Tuesday.

The teen has been receiving care at BC Children’s Hospital in Vancouver since Friday, the same day an initial test came back positive for H5 influenza. Government testing confirmed that the strain is H5N1, the Public Health Agency of Canada said Wednesday.

The young person’s first symptoms, which began a week before they were hospitalized, were conjunctivitis or red eyes, fever and cough, said Dr. Bonnie Henry, an epidemiologist who is the provincial health officer for British Columbia.

The illness has progressed to acute respiratory distress syndrome, or ARDS. People with ARDS typically need help breathing with machines such as a ventilator, but officials did not offer specifics on the teen’s treatment except to say they’re receiving antiviral medications.

This is the first known human case of bird flu acquired in Canada. The country had one case in 2014, which was travel-related, Henry said.

It is still unknown how the teen caught this strain of flu, which has been circulating widely in wild birds, poultry and some mammals, including cattle in North America since 2022.

“Because this is such a rare event and a sentinel event, it is important for us to do as thorough an investigation as possible, and we’re committed to doing that,” Henry said.

There have also been 46 confirmed human infections in the United States as part of the ongoing outbreak this year, mostly among farm workers tending infected animals. All those cases have been mild, and people who have tested positive have recovered from their illnesses after treatment with antiviral medications.

These cases have all been among adults, however, and Henry said it’s possible that the teen’s case is more severe because as a younger person, they’d had less exposure to seasonal strains of the flu, which may offer some degree cross-protection against H5 bird flu strains.

The teen, who was described as healthy before they caught the virus, began experiencing symptoms November 2. They went to an emergency room, were sent home and returned to the hospital a few days later when their condition got worse.

Canadian officials are following more than 40 people who had contact with the teen during their infectious period, which started two days before they began experiencing symptoms.

“I will also say that there are many other tests that are being done on a number of people across the province to try and really get an understanding of what’s happening here,” Henry said.

Officials have no other evidence of anyone else becoming ill after contact with the teen.

“We don’t see right now that there’s a risk of a lot of people being sick,” she said.

More than two dozen poultry farms in British Columbia have been affected by H5N1, Henry said. Since 2022, about 11 million birds have been destroyed, with most of them in British Columbia. Unlike in the US, H5N1 has not been detected dairy cattle or milk in Canada.

“We are looking very, very carefully at all potential animal exposures, bird exposures. There were other pets in the house, and there was contact with pets in other houses,” Henry said. The teen had contact with dogs, cats and reptiles, but none has tested positive for H5N1. Investigators have not identified any contact between the teen and birds.

“Right now, we have no specific source identified, but the testing is ongoing in partnerships with our veterinary colleagues, and we’ll be continuing that investigation very thoroughly,” she added.

The US Centers for Disease Control and Prevention says that the current public health risk remains low but that it’s continuing to monitor the outbreak.

“This is a tragic development. It is an unfortunately unsurprising development,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at the Brown University School of Public Health.

“I think there’s been a lot of wishful thinking about this virus, that it wouldn’t cause people to become severely ill, but that hope, really, I think, stands in contrast to several decades worth of data,” she said.

Since 2003, over 900 human cases of H5N1 have been reported to the World Health Organization. Slightly more than half have been fatal.

“What I think this absolutely underscores is that H5N1 is a very serious public health threat, and we need to be doing more to stay ahead of it, to prevent more people from becoming severely ill or die,” Nuzzo said.

Eight out of 115 dairy workers, or 7%, who worked with H5N1-infected cows in Michigan and Colorado have antibodies to bird flu, according to a new study from the US Centers for Disease Control and Prevention (CDC) – a rate significantly higher than known cases of the highly pathogenic virus, which means existing efforts are not protecting, diagnosing and treating people at risk, experts said.

It could become even harder to detect cases amid the fall migration of wild birds, the upcoming human flu season, and repercussions of the second Trump administration’s proposed policies to curtail public health and expand deportation of immigrants, who serve as the backbone of the agricultural workforce in the US.

The new survey from the CDC and state health departments looked at blood samples from people who worked with H5-infected cows in Michigan and Colorado between June to August 2024.

Out of the eight people who had previously undetected cases of the highly pathogenic bird flu, four remembered having symptoms, mostly conjunctivitis, and the other four did not recall having symptoms.

All eight workers were Spanish speakers who reported milking infected cows or cleaning milk parlors. None of them wore respirators, and less than half wore eye protection like goggles.

Notably, only one person said they had worked with infected cows, even though all of them were working with cows on farms with known infections – pointing to barriers in workers understanding the risks they face.

“It really speaks to the importance of more on-farm training around H5 as well as ways to protect from H5,” Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, told reporters on Thursday.

The news of cases that flew beneath the radar is “completely unsurprising”, said Jennifer Nuzzo, the director of the Pandemic Center and a professor of epidemiology at Brown University School of Public Health.

“When you test people at their place of work, and if the consequence of testing positive is that they have to stay home and possibly not earn an income, you should expect that people might not tell you if they’ve had symptoms. Also, everything we know about flu gives us the very strong suspicion that there would be asymptomatic infections,” Nuzzo said.


Until now, the CDC has recommended testing only people who report symptoms after having direct animal contact.

“We are not doing enough to make sure that we are protecting people from getting infected and certainly making sure that people who are infected get access to medicines that could potentially keep them from getting severely ill,” Nuzzo said.

The CDC is now bolstering measures to protect workers, including expanding recommendations to test farm workers who are exposed to the virus but don’t develop symptoms, and offering those workers access to flu antivirals.

“We in public health need to cast a wider net in terms of who is offered a test so that we can identify, treat and isolate those individuals,” Nirav Shah, the CDC’s principal deputy director, said on Thursday. Identifying cases and treating people helps to keep a mild infection from turning into a severe one – and it reduces the chances that the virus will spread onward among people.

“The less room we give this virus to run, the fewer chances it has to cause harm or to change,” Shah said. The agency is also improving guidance and education on the importance of personal protective equipment.

“Because we haven’t seen severe illness and deaths yet, I think there’s been some complacency around trying to control this virus, but I’ve always said we shouldn’t wait for farm workers to die before we take action to protect them,” Nuzzo said. “I just don’t think you should gamble with people’s lives like that.”

She believes existing stockpiles of H5N1 vaccines should be offered to farm workers, pending their authorization from regulatory agencies. Vaccines can help prevent severe illness, particularly among a population that may be hesitant to come forward with an illness that could jeopardize their job or even their ability to stay in the country.

“Just offer it for people who may want to protect themselves,” Nuzzo said. “This virus is not going away. This virus is going to represent an even greater threat to human health as it continues to find its way into more and more US farms.”

If the “moral imperative” to protect agricultural workers doesn’t move Americans, perhaps the economic effects of higher costs of milk, eggs and meat will, she said. “Nobody wants the cost of groceries to be any higher than they already are.”

So far, there have been 46 official cases of H5N1 diagnosed in people this year, more than half of which have been among dairy farmworkers. Another nine people have now been identified by blood testing, for a total of 55 people affected by bird flu in 2024.

Other influenza variants will soon begin circulation in people this fall, which raises the possibility of reassortment – a process where different flu variants combine and potentially gain worse attributes.

“By allowing this virus to circulate, we could give it a runway to develop the ability to more easily infect people, and crucially, to be able to spread easily between people,” Nuzzo said. “If the virus can do that, we will be in a new pandemic.”

Dairy workers who’ve been exposed to bird flu should be tested for the virus even if they don’t have symptoms and be offered Tamiflu to cut their risk of getting sick, the Centers for Disease Control and Prevention said Thursday.

The recommendation coincides with a new report finding asymptomatic bird flu infection in some workers. Those cases were discovered using blood, or serology, testing and seem to have been transmitted from sick animals, not people.

“There is nothing that we’ve seen in the new serology data that gives us any concern about person-to-person transmission,” Dr. Nirav Shah, the CDC’s principal deputy director, said during a media briefing.

To date, 46 people have been diagnosed with bird flu, also known as H5N1, in the United States this year. All but one of those patients had been exposed to sick cattle or poultry on farms.

Most cases have been reported in California (21), Washington (11) and Colorado (10).

The new CDC study looked at blood tests from workers at 115 dairy farms who were exposed to H5N1 over the summer in either Colorado or Michigan.

Of those 115, eight (7%) had antibodies showing they’d been infected with the bird flu.

“All eight reported milking cows or cleaning the milking parlor,” Dr. Demetre Daskalakis, who heads the CDC’s National Center for Immunization and Respiratory Diseases, said during the call. Masks and safety goggles were rare.

“None wore respiratory protection, and less than half wore eye protection,” Daskalakis said.

Most of those found with H5N1 said they’d had red, itchy eyes with drainage.

But four of the eight who were infected didn’t recall ever being sick.

Until now, workers who had a known exposure to bird flu but didn’t have symptoms haven’t been routinely tested. The new results clearly show cases have been missed — a concern that veterinarians have had since the spring.

The CDC is now “intensifying” recommendations meant to protect farmworkers, Shah said. “We in public health need to cast a wider net in terms of who is offered a test so that we can identify, treat and isolate those individuals,” he said.

The new advice is to test anyone with a significant bird flu exposure, such as an unprotected worker who’s been splashed in the face with raw milk on a dairy farm with known H5N1 infections in the herds.

Even if the person never feels ill, that worker should be tested and given the antiviral drug Tamiflu to reduce their risk of ever developing symptoms or passing the virus to close contacts.

This is a move the CDC should have made months ago, said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health.

“We’ve always suspected strongly and now have confirmation that that was going to miss people who are infected,” Nuzzo said. “This is very bad because one of these infections could turn out to be serious.”

All the H5N1 cases reported so far this year have been mild, including pinkeye and some minor coughs or sneezes. No one has died.

That runs counter to previous H5N1 mortality rate estimates from other parts of the world suggesting more than half of those who become infected die.

Daskalakis said that could be because “not all H5N1s are built the same. These are potentially different genotypes.”

There is no indication that the commercial milk or beef supplies have been affected, the Food and Drug Administration has said.

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Erika Edwards
Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."

Mustafa Fattah
Mustafa Fattah is a medical fellow with the NBC News Health and Medical Unit.

Learn the bipartisan lessons of the past to prevent future biological crises

For decades, American presidential administrations of both parties have made combatting biological threats a priority on their national security to-do list. In 2020, I spoke out about President Donald Trump’s mishandling of the COVID-19 pandemic and dismissiveness towards bipartisan lessons and preparedness tools his team received when he entered office. Though no administration could have been perfectly prepared for COVID, the results of Trump’s disregard were predictable; when the virus struck, chaos ensued. Instead of uniting in the face of crisis, states and cities were left divided and competing for scarce resources. Americans suffered and lives were lost as a result.

Looking forward, important new plans and response playbooks have emerged not only from COVID-19, but from the many additional outbreaks the United States has fought over the last four years from mpox to H5N1 influenza, to Marburg. I draw hope from state and local innovations, such as those uncovered by the American Democracy and Health Security Initiative. The federal government and our nation’s governors, mayors, tribal leaders, school administrators, businesses and community organizations learned precious lessons, which must be preserved. The path ahead for our nation’s biodefense is clear: we must lean into and build on this vital work.

In this spirit, the administration should reject a biosecurity to-do list that sows divisiveness, driving Democrats and Republicans into their respective corners and failing to capitalize on hard-fought lessons from states, cities, and tribes. Instead, it should adopt a bipartisan biosecurity agenda that protects all Americans by onshoring and friend-shoring critical supplies, while simultaneously bolstering global financing solutions that enable low- and lower-middle-income countries to access countermeasures and stop outbreaks at the source. It should double down on investing in the 100 Days Mission, an effort built on Operation Warp Speed, achieve safe and effective vaccines, tests, and treatments for every potentially pandemic pathogen. And it must strengthen preparedness to deter and guard against the potential for deliberate or accidental biological misuse.

Such an agenda would recognize that biological disasters affect everyone, everywhere, all at once and that Americans can only be safe from disease threats if diseases are fought and stopped everywhere in the world. Crucially, this means doubling down on the US target to assist at least 50 countries with health security capacity and catalyze capacity in 50 more through a strong Pandemic Fund. It would require not only remaining at the table in the World Health Assembly, the governing body of the World Health Organization (WHO), but also using that seat to play a stronger leadership role in advancing global health security. Conversely, walking away would have negative impacts on Americans and create space for competitors and adversaries that seek harm to our interests. And it would mean working to build the world’s strongest bioeconomy, safeguarding emerging biotechnologies against deliberate and accidental misuse, and building capacity to detect and respond to disease threats around the world.

Finally, to achieve these goals, the incoming administration must adopt and invest in the work of the National Security Council’s Directorate on Global Health Security and Biodefense and the White House Office on Pandemic Preparedness and Response. These non-partisan experts have spent years building a national and global firefighting team to enhance American readiness for biological threats. This team should be empowered and expanded, not shuttered.

It’s highly likely the incoming administration will have to deal with a major health emergency very early in its tenure. In 2025, we will learn whether the new administration will pick up where it left off or whether it can turn the page on past pandemic performance and prevent future biological catastrophes.

–Elizabeth (Beth) Cameron is a professor of the practice and senior advisor to the Pandemic Center at the Brown University School of Public Health.

Marburg virus is notorious for its killing ability. In past outbreaks, as many as 9 out of 10 patients have died from the disease. And there are no approved vaccines or medications.

That was the grim situation in Rwanda just over a month ago, when officials made the announcement that nobody wants to make: The country was in the midst of its first Marburg outbreak.

Now those same Rwandan officials have better news to share. Remarkably better.

“We are at a case fatality rate of 22.7% — probably among the lowest ever recorded [for a Marburg outbreak],” said Dr. Yvan Butera, the Rwandan Minister of State for Health at a press conference hosted by Africa Centers for Disease Control and Prevention on Thursday.

There’s more heartening news: Two of the Marburg patients, who experienced multiple organ failure and were put on life support, have now been extubated — had their breathing tubes successfully removed — and have recovered from the virus.

“We believe this is the first time patients with Marburg virus have been extubated in Africa,” says Tedros Adhanom Ghebreyesus, director general of the World Health Organization. “These patients would have died in previous outbreaks.”

The number of new cases in Rwanda has also dwindled dramatically, from several a day to just 4 reported in the last two weeks, bringing the total for this outbreak to 66 Marburg patients and 15 deaths.

“It's not yet time to declare victory, but we think we are headed in a good direction,” says Butera. Public health experts are already using words like “remarkable,” “unprecedented” and “very, very encouraging” to characterize the response.

How did Rwanda — an African country of some 14 million — achieve this success? And what can other countries learn from Rwanda’s response?

Doing the basics really well
Rwanda is known for the horrific 1994 genocide — one of the worst in modern times. Since then, the country has charted a different path. In 20 years, life expectancy increased by 20 years from 47.5 years old in 2000 to 67.5 years old in 2021 — about double the gains seen across the continent. And Rwanda has spent decades building up a robust health-care system.

“The health infrastructure, the health-care providers in Rwanda — they're really, really great,” says Dr. Craig Spencer, an emergency physician and professor at Brown University School of Public Health. Spencer specializes in global health issues and has been following the Rwandan outbreak closely.

There are well-run hospitals and well-trained nurses and doctors, he says. There are laboratories that can quickly do diagnostic testing. There is personal protective equipment for medical workers.

For this outbreak, there was the know-how and infrastructure to set up a separate Marburg treatment facility. That's been a boon for other patients and medical staff, preventing exposure to the virus — which crosses over from bats to humans and can be transmitted through bodily fluids like blood, sweat and diarrhea.

And even though there aren't approved medications to treat Marburg, patients in Rwanda have received good supportive care for all their symptoms — like the IV fluids critical for symptoms like high fevers, nausea, vomiting and diarrhea.

This stands in stark contrast to the response in past Marburg scenarios. For example, the Democratic Republic of Congo — next door to Rwanda — had an outbreak between 1998 and 2000. Dr. Daniel Bausch, now a professor at the London School of Hygiene and Tropical Medicine and an expert in tropical diseases like Marburg, provided care in that outbreak. He says what the country’s health centers were able to offer patients was rudimentary at best.

“We called it a care center or treatment center, but really it was a separate mud hut that people were placed in. We didn't have really anything available to us,” he remembers. “People were lucky that they got paracetamol, or Tylenol, and some fluids to drink, if they could get them down without the nausea and vomiting preventing them.”

In the world's 18 recorded Marburg outbreaks, the mortality rate varies considerably. Several small outbreaks have had fatality rates below 30% but the largest outbreak — in Angola in 2004 and 2005 — had a case fatality rate of 90% with 252 cases and 227 deaths.

Rwanda’s “more modern medical centers” make a big difference, Bausch says.

Getting to patients lickety-split
It wasn’t just the caliber of care that made a difference. It’s also the speed with which patients get care.

As soon as the outbreak started, Rwandan officials jump-started a major operation to trace the contacts of those who were infected, monitoring the health of over 1,000 family members, friends, health-care workers and others at risk. They also started door-to-door surveillance in neighborhoods where there might have been an exposure.

And they did a lot of testing – over 6,000 tests, especially among health-care workers, who’ve comprised 80% of the Marburg patients in this outbreak.

Spencer says many of these capabilities were built up during the COVID pandemic and could be rolled out rapidly. “In Rwanda, you have providers able — within hours really of this outbreak being declared — to get tested,” says Spencer, who has worked with Doctors Without Borders treating Ebola patients. “[Rwanda’s testing is] absolutely remarkable in terms of the response.”

This surveillance and testing allowed “us to detect cases quickly and provide them with treatments in the very, very early phases of their diseases,” explains Butera. He says that caring for patients before they become critically ill likely helped lower the mortality rate.

Embracing experimental vaccines and medications
Rwanda’s speed carried over into other anti-Marburg efforts.

“Everything I have witnessed was really expedited,” says WHO’s Ghebreyesus, who visited Rwanda last week and said what he saw was “very, very encouraging.”

While there are no vaccines or treatments approved for Marburg, Rwanda acted quickly to get experimental vaccines and treatments to people at the center of the outbreak.

“I can't imagine another scenario in which a country went from identifying this outbreak to just over a week later having investigational [experimental] vaccines in country already being provided to frontline health-care workers,” says Spencer, who adds the doses started being administered the same day they arrived in the country. The nonprofit Sabin Vaccine Institute provided the doses, which were developed with major support from the U.S. government.

“I rarely, rarely use the word unprecedented in global health response” Spencer says, but this speed was “unprecedented.”

The vaccine itself is still in development. Testing has shown that it’s safe — but not whether it actually works. Nonetheless, Rwanda decided to inoculate those at risk, hoping that it would help.

Those officials also decided to vaccinate without a randomized controlled trial, where a segment of the recipients get a placebo. Some in the international scientific community say this was a missed opportunity to start learning whether the vaccine is effective — although they concede that it’s far more complicated and slow to roll out a trial. And the size of the outbreak was unlikely to yield enough data to be conclusive.

Did the vaccines help stop the spread or reduce the mortality rate? It’s impossible to know, says Bausch. He points out that in the first recorded Marburg outbreak — in 1967 in Marburg, Germany and what was then Yugoslavia — the mortality rate was 23% with only good supportive care.

Meanwhile, in Rwanda, the next round of vaccines will go to at-risk groups, including mine workers who are in close proximity to the fruit bats that can spread Marburg; that vaccine effort will be randomized.

In addition to the vaccines, Rwanda very swiftly started giving patients two medications — an antiviral called Remdesivir and a monoclonal antibody. As with the vaccine, they hoped these treatments would help even though they haven’t been approved for Marburg.

An early stumble, a course correction
In addition to the speed and high-quality patient care, there’s another less glamorous — but equally important — dimension to quashing Marburg and other viruses, says Bausch. It’s infection control: basically, ensuring Marburg patients don’t infect others. In the hospital, this means that staff take precautions like wearing gowns, masks and double gloves. In public, it can mean sanitizing shared items like motorcycle helmets and installing handwashing stations in public places, as Rwanda has done.

Rwanda stumbled early on with infection control. That’s because it took a couple weeks to diagnose the disease in the individual who is considered the first patient in this outbreak — and the first known Marburg case in the country.

That individual, who likely contracted the virus from exposure to fruit bats in a mining cave, also had a severe case of malaria. Clinicians did not determine that Marburg was also present until other people around that patient started falling ill. As a result, many health care workers were exposed before infection control measures were improved.

While Rwanda rapidly improved their infection control once officials understood what they were dealing with — and not just in health facilities. The mining community linked to the initial patient has seen several cases. So surveillance needs to be sure to cover those populations, says Rob Holden, WHO’s incident manager for Marburg.

“As we go forward, we fine tune, we refine, we reinforce all our surveillance systems, our contact follow ups, our investigations, and we leave no stone unturned,” he says. “If we let our guard down, then I think we'll end up with some nasty surprises and a very long tail on this outbreak.”

Spencer agrees. But he is optimistic. He says that Rwanda’s robust health infrastructure and speedy response has helped protect the rest of the world from a much bigger Marburg outbreak.

NEW YORK (AP) — A pig at an Oregon farm was found to have bird flu, the U.S. Department of Agriculture announced Wednesday. It’s the first time the virus has been detected in U.S. swine and raises concerns about bird flu’s potential to become a human threat.

The infection happened at a backyard farm in Crook County, in the center of the state, where different animals share water and are housed together. Last week, poultry at the farm were found to have the virus, and testing this week found that one of the farm’s five pigs had become infected.

The farm was put under quarantine and all five pigs were euthanized so additional testing could be done. It’s not a commercial farm, and U.S. agriculture officials said there is no concern about the safety of the nation’s pork supply.

But finding bird flu in a pig raises worries that the virus may be hitting a stepping stone to becoming a bigger threat to people, said Jennifer Nuzzo, a Brown University pandemic researcher.

Pigs can be infected with multiple types of flu, and the animals can play a role in making bird viruses better adapted to humans, she explained. The 2009 H1N1 flu pandemic had swine origins, Nuzzo noted.

“If we’re trying to stay ahead of this virus and prevent it from becoming a threat to the broader public, knowing if it’s in pigs is crucial,” Nuzzo said.

The USDA has conducted genetic tests on the farm’s poultry and has not seen any mutations that suggest the virus is gaining an increased ability to spread to people. That indicates the current risk to the public remains low, officials said.


A different strain of the bird flu virus has been reported in pigs outside the U.S. in the past, and it did not trigger a human pandemic.

“It isn’t a one-to-one relationship, where pigs get infected with viruses and they make pandemics,” said Troy Sutton, a Penn State researcher who studies flu viruses in animals.

This version of bird flu — known as Type A H5N1 — has been spreading widely in the U.S. among wild birds, poultry, cows and a number of other animals. Its persistence increases the chances that people will be exposed and potentially catch it, officials say.

It isn’t necessarily surprising that a pig infection was detected, given that so many other animals have had the virus, experts said.

The Oregon pig infection “is noteworthy, but does it change the calculation of the threat level? No it doesn’t,” Sutton said. If the virus starts spreading more widely among pigs and if there are ensuing human infections, “then we’re going to be more concerned.”

So far this year, nearly 40 human cases have been reported — in California, Colorado, Washington, Michigan, Texas and Missouri — with mostly mild symptoms, including eye redness, reported. All but one of the people had been to contact with infected animals.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.